Prenatal and Perinatal Psychology

The global burden of psychiatric disorders in women is on the rise, especially in the perinatal period.
Despite this, the recognition of the need and delivery of health care in women of reproductive age
group is scarce and still met by unscientific treatment modalities. Such a scenario is luring in India
as well. We have focused on discussing the impact of culture on the treatment practices, different
challenges faced, nosological status, and management principles of different perinatal psychiatric
disorders. We mainly employed the Google Scholar search engine to look into articles of all
sorts (review articles, case reports, expert opinions, newspaper extracts, and Indian government
websites) and reviewed them. We also acknowledged the information extracted from these articles
which were highly valuable and enlightening. The perspective of the health‑care delivery in the
perinatal group of population has been changing over the years, but still there is lot to change.
A holistic, scientific, evidence‑based approach is a definite need toward attaining this goal.

As professionals working and researching within both the prenatal and infancy domains of human development and psychology, it has become clear to us that a mental divide exists in our culture and professional practice that separates the prenatal world from that of infancy. Professionals are trained to work within one domain or the other; agencies and services are funded for one or the other. Until now there has not been a logical reason to do otherwise. However, we see a shift on the horizon.

Research in the prenatal human experience has very clearly shown that whatever mother experiences all her life until conception and even more impactfully during conception and pregnancy passes down to the child she is pregnant with. Modern Biology has shown that environmental information and the perception that governs this environment gets encoded in the cell consciousness. A simple thought or act can upset or stabilize the whole planet or... fetal existence. Subtle differences in the motivation of our choices may have the power to bring about radically different conditions in the process of events. A simple thought of fear can lead to a trauma, a disease, a holocaust while a simple thought of compassion can take humanity out of the platonic cave into the healing light of creation. Is there anything we can do? Can we learn from what we already know about prenatal dynamics and move on to design and implement salutogenic processes for the benefit of all involved? The paper will attempt to show the most important findings about prenatal dynamics and fetal existence and how they are connected with our postnatal health and wellbeing from the times of Freud and especially his students who took psychoanalysis from the childhood to birth experience and then to pregnancy and conception and beyond.

AIM:
The aim of this study was to investigate fathers' emotional experiences of their infant's preterm birth and subsequent stay in neonatal intensive care unit.

BACKGROUND:
When a baby is born preterm, there is also the premature interruption of the process of preparation for fatherhood. As a result, the impact on fathers of the preterm birth can bring negative consequences for the development of father-infant relationship.

DESIGN:
A multi-method approach was used which included ethnographic observation, semi-structured interviews with fathers, a self-report questionnaire and clinical information between September 2015-March 2017.

METHOD:
Data were analysed using a mixed-method: a thematic analysis of data from the interviews and quantitative analyses to detect possible clusters of fathers' emotional experiences and associations between clusters and fathers' and/or infants' characteristics.

RESULTS:
Two clusters were identified. The "fathers-of-preterm-infants" touched their baby as soon as they were given the opportunity and without fear that they would harm their infant. They were struck by their baby's physical appearance. In contrast, the "preterm fathers" preferred not to touch their baby when first given the chance, for fear of breaking/damaging/infecting her/him. They were struck both by the baby's physical appearance and by the technology/equipment around her/him and were afraid that their infant would die. All the "fathers-of-preterm-infants", but only just over half of the "preterm fathers", were actively engaged in their infant's care. Clusters were associated with the infant's gestational age.

CONCLUSION:
Fathers of preterm infants should receive personalized support specifically addressed to them and based on the infant's gestational age.

Für die 28. Jahrestagung der ISPPM e.V. im Jahr 2016, dem letzten Amtsjahr unseres seit sechs Jahren amtierenden Präsidenten Prof. Dr. Hildebrandt, haben wir ein Thema gewählt, das die komplexen Wechselwirkungen zwischen Geburtskultur und seelischer Gesundheit im gesellschaftlichen Kontext beleuchten soll.

The main issue of the present monograph may be expressed in a simple question: What is prenatal education and pedagogy? The question may be alternatively formulated as: What is the methodological status of prenatal education and pedagogy? The issue is elaborated in the following set of questions:
1. What is the justification for distinguishing prenatal education and pedagogy in the context of the development of the contemporary educational sciences?
2. How could the methodological status of prenatal education and pedagogy be outlined (its object, scope of research, aims (goals and purposes), cooperation with other sciences, organisational facilities)?
3. What could be the theoretical and applicative significance of establishing a distinct discipline of prenatal education and pedagogy?
The theoretical aim of the book is to justify the institution of prenatal education and pedagogy among the educational sciences and to establish its preliminary methodological status as a discipline in education and pedagogy, characterised by a dynamically developing field of research and practical application. This goal has been achieved by the specification of the scope of interest of prenatal education and pedagogy and initial establishment of its methodological status as a new, dynamically developing discipline in education and pedagogy, taking into account its interdisciplinary character and the context of related scientific disciplines, as well as their applicative potential.
The practical goal of the publication is to introduce a broader understanding of prenatal education and convince the reader about the possibility of parenting and raising a prenatal child, and to  provide knowledge necessary to establish a core curriculum for the teaching of prenatal education and pedagogy to students of psychology, education, pedagogy, family studies, medicine, nursing and obstetrics. The expected practical results also include a broadened knowledge of prenatal psychology and pedagogy, and the prenatal period of human life – necessary for the cooperation between education and pedagogy specialists, psychologists, and the medical staff: gynaecologists, obstetricians, midwifes, the personnel working genetic in counselling, prenatal diagnostics services and family social services, including pregnancy support groups, birth classes, family birthing centres.
The present dissertation, presenting the concept of prenatal education and pedagogy, introduces terms which are new to education and pedagogy in Poland (most of them have been used in the author’s earlier publications), such as: the prenatal child, prenatal education, the prenatal educational environment, the educational environment of the womb, prenatal dialogue, bi-subjectivity of prenatal education, prenatal maternity, prenatal paternity, prenatal parenthood, prenatal parents, prenatal personalism, prenatal parenting activity, prenatal educational impact, ‘person-creating’ character of the mother’s womb, prenatal educator, prenatal violence, prenatal child abuse.
The book consists of 7 chapters. The first part of the monograph concerns the sociocultural context which justifies the need to establish the discipline of prenatal education and pedagogy. It discusses the impact of the ideology of postmodernism on attitudes towards the human sexual sphere and contemporary transformations in attitudes to procreation and procreational activities (positive and negative changes, e.g. the demographic crisis, the involvement of the father in the process of procreation).
Facing the rising social awareness of the possible forms of violence against the prenatal child and the factors which might distort its development, the second chapter is a reflection on various forms of prenatal relations between the parents and the child, especially the negative ones, and the potential benefits of applications of prenatal education and pedagogy, i.e., to prevent or lessen the effects of the negative relations which might distort the process of procreation and the development of the child. The attitudes of the parents are largely related to their hierarchy of values and their lifestyle, which is also dependent on the social context of their existence, and the mother’s personality and life history.
The third chapter presents the so-called new approach to procreation and the prenatal child, which – as opposed to the biologistic approach applied to date – is characterised by a personalistic paradigm. The new approach is reflected in the structures of prenatal education and pedagogy that constitute it as a scientific discipline, such as various scientific organisations, journals, research centres and activities (conferences, publications, and social structures, e.g. trainings, birth classes), especially those present in Poland which concern the psycho-pedagogical aspects of procreation and the prenatal period of life. These efforts have established the basis for the proposal to develop prenatal education and pedagogy as a new discipline in the educational sciences. The chapter develops the claim that modern education and pedagogy has matured to recognise within its field a discipline that deals with the theory of prenatal education and pedagogy, as the subjective-personalistic dimension of this area of interest – proposed by the academic centres, conferences and organisations involved in prenatal education and pedagogy – calls for its establishment as a separate discipline within education and pedagogy.
Chapter 4 analyses the challenges within education and pedagogy itself, reflected in the literature of the field. Starting with an introduction of the ideas of the “forefather” of Polish family and health pedagogy, J. Śniadecki, followed by a characterisation of early childhood as the object of interest of education and pedagogy in the 20th century, and a description of the current tendencies observed within education and pedagogy (interest in ever earlier development of the child and the child’s life environment, the biographic and narrative approach), the chapter  shows the present state of literature connected with the area described as prenatal education and pedagogy.
Chapters 5 and the following ones are of key importance, as they present the original proposal for the methodological status of prenatal education and pedagogy as a new discipline in educational sciences, which arises from scientific discourse and psycho-pedagogical practice. This part of the book attempts to describe the methodological specifics of prenatal education and pedagogy (its subject, aims, methods, fields of cooperation with other areas of education, and its interdisciplinary character).
In terms of the proposed cooperation of prenatal education and pedagogy with other educational disciplines, firstly, the book discusses its relations with family education and pedagogy, health education and pedagogy (health education, health promotion), care education and pedagogy and special pedagogy, as they seem to be the closest in nature (chapter 6). The character of their cooperation justifies the establishment of prenatal education and pedagogy as a separate discipline within educational sciences. The possible links between prenatal education and pedagogy, social education and pedagogy, and adult education and pedagogy (andragogy) are presented. The book also describes the area of cooperation between Christian education and pedagogy and prenatal education and pedagogy, mentioning the spiritual aspects of procreation, the spirituality of the prenatal child, seeing the child both as a gift to be brought up by its parents, as well as a gift which develops the parents (who help the child to develop, and by doing so, they develop themselves), religious inspirations for prenatal education, the educational dimension of prenatal communication, indicating the threats to a scientific approach to the prenatal period of human life brought by the various semi-religious ideologies, parapsychology, occultism, magic or spiritual practices isolated from their philosophical-religious context.
The following chapter (chapter 7) points to the academic context of the emergence of prenatal education and pedagogy, in answer to the challenges related to the development of psychology, especially prenatal psychology, biological and medical sciences, the humanities and philosophy. The book presents the possible forms of cooperation for prenatal education and pedagogy and psychology (life-span psychology, prenatal psychology, psychology of life crises, gerontopsychology, developmental, family, educational, social, clinical psychology, psychology of disabled persons, cultural psychology, psycholinguistics) and wishes to justify the need to recognise prenatal education and pedagogy – the field of human procreation and the prenatal period of human life – as a new discipline in education and pedagogy. Therefore, the book presents possible common areas of interest for prenatal education and pedagogy and the biological sciences (behavioral genetics, behavioral endocrinology, behavioral teratology) and medical sciences (diagnostic techniques and services, education of medical staff), as well as the social sciences (sociology), legal sciences, music studies, philosophical anthropology and ethics. Education and pedagogy, also through the proposed prenatal pedagogy, is able to cooperate with other disciplines of science, contributing what is specific to its approach to solve the current problems in the field of procreation and the first period of human life.
The final part contains a set of conclusions referring to the prospects of development for prenatal education and pedagogy as a science and its expected contribution to the study of the human being.
It is important to prevent all that does not allow to optimally use the experience of procreation, and to create favourable conditions for a positive development of the child.
Translated by Aleksandra Biela-Wołońciej

"Three Identical Strangers" is a documentary film telling a "bizarre" story of American triplets. Wathching  this film we may wonder: "Do we live in a “chancy, chancy, chancy world?" The Effect of Celestial Twins (ECT) rejects the idea of such an improbable universe and proposes instead a hypothesis that a new temporal  factor (the Theta-factor) plays an important role in shaping our personalities and life-paths.

Objective: The aim of this study is to adapt the Perinatal Post Traumatic Stress Disorder Questionnaire- II (PPQ-II) and determine the psychometric properties of this scale.
Method: The study was conducted with two different samples consisting of mothers who give full-term and preterm birth. To investigate the factor structure and conduct confirmatory factor analysis, the first sample was composed of 194 women between the ages of 18-43 (Mean=30.12, standard deviation [SD]=4.96). The second sample in which confirmatory factor analysis was conducted consisted of 238 women between the ages of 19-43 (Mean=30.33, SD=4.00). Depression Anxiety Stress Scale and Connor-Davidson Resilience Scale were used in this study as well as PPQ-II.
Results: The exploratory and confirmatory factor analysis revealed a two-factor structure named “Intrusive Thoughts and Avoidance” and “Hyperarousal and Numbness Responses”. The model obtained by confirmatory factor analysis demonstrated acceptable goodness of fit values and the questionnaire was found to have satisfactory reliability and validity values.
Conclusion: PPQ-II could be considered as a valid and reliable scale which could be used in maternal mental health studies conducted in Turkey.
Keywords: Factor analysis, perinatal trauma, PTSD, reliability, validity

Renaissance physicians and midwives had many tools at their disposal; balms, tinctures, poultices, even rudimentary diagnostic testing and surgical procedures. However, most health maintenance was done by controlling diet.  Proper humoral balance, achieved through proper diet and preparation, was central to classic medical theory which became the basis for Renaissance dietary theory. There was a booming market across Europe for health manuals, reminiscent of today’s self-help, beauty, pregnancy and diet books.  This paper will examine some of the dietary recommendations for pregnant woman in one of these health manuals, Michele Savonarola’s Ad mulieres ferrarienses, and compare them with similar references in contemporary sources and modern medical research.

The monograph is devoted to complex problem situations that occur in everyone's life. The authors consider different types of life crises, normative and non-normative, explore ways of psychological support and assistance to a person, offer certain methods of self-help. The book is addressed to psychologists, suicidologists, sociologists, social workers, a wide range of readers.

Il presente lavoro intende far emergere le peculiarità del processo di soggettivazione di un gemello rispetto ad un nato singolo. Al fine di ciò, è stata posta la vita prenatale della coppia come oggetto d’indagine, in quanto ritenuta la primaria fonte di esperienza dell’Altro e il nucleo centrale dello scarto tra gemello e fratello.

This paper was originally published in Adventist Review, April 17, 2014 issue. It describes the views of Ellen G. White (1827-1915), one of the founders of Adventism, concerning prenatal influence of the parents upon the children. Ellen White was a century ahead of her time in claiming that parents emotional and spiritual condition affect spiritually and biologically the development of children's characters and attitudes before they are even born. This article is geared most to an Adventist audience, although an open non-Adventist can certainly be benefited by it as well.

Pregnancy as a feminine initiation becomes conscious to a woman when she engages with her pregnant imagination through dreams, art, emotions, and somatic changes. If the woman acknowledges her emotional and psychological reactions arising from core archetypal patterns, a "conscious pregnancy" occurs. Three stages of the initiation are outlined: Gateway, Attending, and Passage. Focusing on the Attending stage, three key psychological components are explored: shadow, syzygy, and simultaneity. Viewing the prenatal psyche through C.G. Jung's lens of Analytical Psychology sheds light on how archetypal patterns and symbolic material associated with initiatory tasks supports maternal confidence and enhances mother/infant attachment.

Amy Lauren Shapira, M.A., is a physical therapist, childbirth educator, and lactation instructor. She holds a Master's degree in pre-and perinatal psychology from Santa Barbara Graduate Institute. Her master's project—Prenatal and perinatal psychology: A review of the history, principles, clinical findings, scientific basis and applications—is the basis for a Hebrew-language internet resource (www.ppn-info.net) for the Israeli public, and is the first Hebrew website on pre-and perinatal psychology. Amy had worked for years instructing couples before birth and has led infant massage courses for mothers and babies. She has lectured in childbirth educator and doula certification courses for over a decade and is currently a medical librarian at the Younes & Soraya Nazarian Library at Haifa University in Israel. Amy is married and has three children. She can be reached at: [email protected]. Abstract: Cesarean delivery rates have been steadily rising and have reached startling rates worldwide. There is a consensus among pre-and perinatal psychology clinicians that prenatal and perinatal factors create a predisposition that may be exacerbated and adversely affect one's personality. Although a cesarean delivery is a lifesaving procedure, little attention and respect have been given to the cesarean born baby's emotional well-being. This article's aim is to investigate whether being born in a cesarean delivery can emotionally and behaviorally impact the cesarean born throughout life, by reviewing the existing pre-and perinatal psychology literature and the current medical literature.

Objectives: critical review of etiological theories of phenomena reported in Holotropic Breath- work [HB]. Method: literature on Holotropic Breathwork, hyperventilation syndrome, polyvagal theory, SARs theory, classical mytho-poetic traditions, the role of music, anomalous experiences and healing, and classical psycho-spiritual explanatory models are reviewed. Discussion: physiological and neurophysiological models, transpersonal, and cognitive psychological models, ethno-epistemological problems and methodological concerns are reviewed. Narrative logic versus stochastic models is ex- amined. Conclusions: voluntary over-breathing and music provide access to non-ordinary states through the putative effects of vagal toning and sonic integration. Cognitive processes may play a role in permit- ting the anomalous internal narrative experiences.

This theoretical thesis will conceptualize how the capacity of a healthy pregnancy and birth and positive attachment could be a corrective experience for mothers with histories of trauma and subsequent substance use. Socratic questioning is used to help trauma and attachment-informed clinicians approach mothers in this population as an asset to their infants rather than viewing them as a risk, hopefully challenging the socially prevalent trend to believe that these mothers should be treated punitively rather than receive treatment. The phenomenon also focuses on this population of mothers rather than their infants as primary victim, examining individual and systemic factors that contribute to substance use in pregnant mothers as a means by which they cope with their own history of trauma. In addition, the author conducted assessments of what types of programs currently exist for these mother and what are the barrier and successes to providing trauma and attachment informed care for these women.

Prenant la suite de l’étude de Claudia Pancino (université de Bologne) sur les représentations du fœtus à l’âge classique, la seconde partie de Formato nel segreto, Nascituri et feti fra immagini e immaginario dal XVI al XXI secolo (Carocci, Roma, 2006) présentée ici en français, porte sur l’histoire de la visualisation du fœtus in utero et de l’imagerie fœtale dont les prémices remontent au XIXème siècle. Cette histoire relève aussi bien de l’histoire médicale et de l’histoire des techniques, de l’histoire du regard et du visible, que de l’essor de la psychologie périnatale et des transformations de notre imaginaire de la naissance.

The purpose of the following paper is to examine a hard and scarcely discussed topic, fetal conditioning and rituals of the prenatal development, first from the western perspective of advanced research in fetal psychology and clinical treatment using fetal conditioning, and then from a cross-cultural and interdisciplinary perspective. The second section, the more emphasized one, attempts to shed light on the symbols and archetypes of the fetus as they emerge from various traditional ancient and still existing cultures as well as New Age religious customs and rituals associated with prenatal development, a special and quite interesting issue.

Mental disorders are among the most common morbidities of pregnancy and the postnatal period, and can have adverse effects on the mother, her child, and family. This Series paper summarises the evidence about epidemiology, risk factors, identification, and interventions for non-psychotic mental disorders. Although the phenomenology and risk factors for perinatal mental disorders are largely similar to those for the disorders at other times, treatment considerations differ during pregnancy and breastfeeding. Most randomised controlled trials have examined psychosocial and psychological interventions for postnatal depression, with evidence for effectiveness in treating and preventing the disorder. Few high-quality studies exist on the effectiveness or safety of pharmacological treatments in the perinatal period, despite quite high prescription rates. General principles of prescribing of drugs in the perinatal period are provided, but individual risk-benefit analyses are needed for dec...

Aims and objectives: The aim of this systematic review was to summarize the key findings of empirical studies assessing the influence of maternal depression on child attachment security measured before 24 months after birth. Method: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. A literature search was conducted on the EBSCO (Academic Search Complete; Health Source: Nursing/Academic Edition; MEDLINE; PsycARTICLES) and PubMed databases, with infant attachment AND depression as search terms with Boolean operators. Study design or sample size did not affect inclusion. After screening, 29 of the 1510 unique publications originally identified were included in the review. Results: The studies reveal an equivocal association between maternal depression and child attachment security. Our findings indicate that depression had a significant influence on the attachment style almost only when diagnosed by structured interview: Depression measured by self-descriptive questionnaires was unrelated to attachment style. Furthermore, postpartum depression was found to be significant only when measured up to six months after childbirth. Conclusion: The relationship between maternal depression and infant attachment is both complex and dynamic, and the possible negative effects of depression might be compensated by maternal involvement in childcare. Therefore, further studies in this area should employ a reliable methodology for diagnosing depression and a suitable time point for measuring it; they should also adopt a multifactorial and prospective approach. It is important to note that breastfeeding/formula feeding was omitted as a factor in the majority of studies.

Aim The main aims of the study were to examine whether human neonates' responses to communication disturbance modelled by the still-face paradigm were stable and whether their responses were affected by their previous experience with the still-face paradigm. Methods The still face procedure, as a laboratory model of interpersonal stress, was administered repeatedly, twice, to 84 neonates (0 to 4 day olds), with a delay of an average of 1.25 day. Results Frame-by-frame analysis of the frequency and duration of gaze, distressed face, crying, sleeping and sucking behaviours showed that the procedure was stressful to them both times, that is, the still face effect was stable after repeated administration and newborns consistently responded to such nonverbal violation of communication. They averted their gaze, showed distress and cried more during the still-face phase in both the first and the second administration. They also showed a carry-over effect in that they continued to avert their gaze and displayed increased distress and crying in the first reunion period, but their gaze behaviour changed with experience, in the second administration. While in the first administration the babies continued averting their gaze even after the stressful still-face phase was over, this carry-over effect disappeared in the second administration, and the babies significantly increased their gaze following the still-face phase.

"Every NHS hospital should have a liaison psychiatry service as standard, according to a new report from Centre for Mental Health and the NHS Confederation Mental Health Network.
Liaison psychiatry services provide immediate access to specialist mental health support for people being treated for physical health problems, most often in general hospitals and in some cases in the community.
The report, Liaison Psychiatry in the Modern NHS, finds that liaison psychiatry services can save an average hospital £5 million a year by reducing the number and length of admissions to beds. It adds that even bigger savings could be achieved in future if liaison psychiatry services were extended to work in the community to prevent crises from happening at all.
People who have a long term physical health condition are more than twice as likely to have a mental health problem as the general population. This can have a huge effect on a patient's chances of recovery. For example, someone with chronic heart failure is eight times more likely to die within 30 months if they also have depression. Altogether, there are over 4.6 million people with a long term physical health condition and co-morbid mental health problem, all of whom would benefit from more integrated physical and mental health care.
Half of all hospital inpatients have mental health conditions such as depression and dementia. Identifying and managing these conditions quickly and effectively helps people to recover and reduces their length of stay in hospital.
There is a wide variation in the way liaison psychiatry services work and who they help. Many offer training and support to other clinical staff as well as providing mental health care themselves.
The report concludes that well run liaison psychiatry services can be highly cost-effective, saving more money than they cost. The greatest immediate impact can be achieved by supporting older patients in hospital but liaison psychiatry services also have the potential to offer better care at potentially lower cost to many other groups, both in hospital and in the community."

Parent-child relationships play a crucial role in shaping our developing nervous
systems, exerting a particularly strong influence in early life during pregnancy, labor, and
delivery. Their vital role continues through infancy, into adolescence and beyond. Indeed,
these relationships affect us across multiple generations, influencing not only our genes
and behaviors, but impacting our nervous systems and physiologies as well. Because the
nervous system regulates and interacts with all other organ systems, factors that influence
its regulatory relationships and patterns may also have an impact on health and risk for
disease.
Early relationships and traumatic life events represent environmental factors that
interact with genes to shape our capacities for self-regulation. These factors also
influence how we respond to life in general, and to stress in particular. A model for
understanding the role of environmental factors in the origins of chronic illness is
proposed, applying growing scientific research from the psychophysiology, neurology,
and biology of bonding and traumatic stress as a means for elucidating findings from
clinical, pathophysiological, and epidemiological studies of chronic illness. The
integration of this multidisciplinary information suggests a link between early life events
and relationships, long-term health, and risk for disease. These perspectives also have
meaningful implications for individual, societal, and global health, and offer insights
regarding the development of effective strategies for prevention and treatment.

A womb-like experience may not be as universally comfortable, soothing, and safe as the "folk" understanding of this environment implies. In spite of the physical layers of muscle and skin protecting it from the outside world, the fetus is highly sensitive to every nutrient ingested and hormone secreted by its mother. Some effects of maternal stress, such as prematurity and low birth weight, have been thoroughly tested (Rondo et al., 2003; Torche, 2011; Wadhwa, Sandman, Porto, Dunkel-Schetter, & Garite, 1993). For example, some studies have shown that children exposed to prenatal stress develop language later than a non-stressed control group (Talge, Neal, Glover, & Network, 2007). A growing body of research also indicates that prenatal influences contribute to the development of psychiatric disorders such as anxiety, depression and externalizing behavior problems (Davis, Glynn, Waffarn, & Sandman, 2011).The lasting impact on the offspring's brain and behavior is still...

Zusammenfassung Die Tradition der Psychoanalyse ist durch Brüche und Spal-tungen belastet, deren Folgen meines Erachtens bisher nicht ausreichend reflektiert wurden. Das betrifft insbesondere die Zeitbezogenheit einiger psychoanalytischer Konzepte und die Erlebnisbedeutung der frühesten Erfahrung mit der Mutter vor und während der Geburt. Ein wesentlicher Grund für die unvollständige Erfassung der Wirklichkeit der prä-und perinatalen Erfahrungen liegt in den zeitbedingten und persönlich bedingten Begrenzungen der Erkenntnismöglichkeiten Freuds, die in An-betracht seiner großen Entdeckungen und aus Loyalität nicht ausreichend reflektiert wurden. Die genannten Brüche waren oft kompromisshafte " Lösungen " in Bezug auf unterschiedliche Wahrnehmungen, die aber auch mehr, als es jeweils bewusst war, einen Verlust an substanziellen Einsichten bedeuteten. Die Folge dieser Situation ist die, dass wir heute eine Vielfalt von Schulen und Gruppen um Teileinsichten haben, die aber der Gruppenidentität zuliebe oft unbegründet verallgemeinert werden. Der Beitrag will ein Versuch zur Reflexion dieser Situation und ihrer Hintergründe sein. Freud and the prenatal and perinatal dimension of psychological experience Abstract The tradition of psychoanalysis is burdened with fractures and splitting, the consequences of which have not yet, in my opinion, been adequately reflected. This concerns in particular the time-relatedness of some psychoanalytical concepts and the experiential importance of earliest experiences with the mother before and during birth. A fundamental reason for the incomplete apprehension of the reality of prenatal and perinatal experiences lies in the era-dependent and personally related

Background: Prenatal assessment for psychosocial risk factors and prevention and intervention is scarce and, in
most cases, nonexistent in obstetrical care. In this study we aimed to evaluate if the KINDEX, a short instrument
developed in Germany, is a useful tool in the hands of non-trained medical staff, in order to identify and refer
women in psychosocial risk to the adequate mental health and social services. We also examined the criterionrelated
concurrent validity of the tool through a validation interview carried out by an expert clinical psychologist.
Our final objective was to achieve the cultural adaptation of the KINDEX Greek Version and to offer a valid tool for
the psychosocial risk assessment to the obstetric care providers.
Methods: Two obstetricians and five midwives carried out 93 KINDEX interviews (duration 20 minutes) with
pregnant women to assess psychosocial risk factors present during pregnancy. Afterwards they referred women
who they identified having two or more psychosocial risk factors to the mental health attention unit of the
hospital. During the validation procedure an expert clinical psychologist carried out diagnostic interviews with a
randomized subsample of 50 pregnant women based on established diagnostic instruments for stress and
psychopathology, like the PSS-14, ESI, PDS, HSCL-25.
Results: Significant correlations between the results obtained through the assessment using the KINDEX and the
risk areas of stress, psychopathology and trauma load assessed in the validation interview demonstrate the
criterion-related concurrent validity of the KINDEX. The referral accuracy of the medical staff is confirmed through
comparisons between pregnant women who have and have not been referred to the mental health attention unit.
Conclusions: Prenatal screenings for psychosocial risks like the KINDEX are feasible in public health settings in
Greece. In addition, validity was confirmed in high correlations between the KINDEX results and the results of the
validation interviews. The KINDEX Greek version can be considered a valid tool, which can be used by non-trained
medical staff providing obstetrical care to identify high-risk women and refer them to adequate mental health and
social services. These kind of assessments are indispensable for the promotion of a healthy family environment and
child development.

El embarazo y el parto son acontecimientos vitales de gran importancia en el desequilibrio emocional en algunos casos. Aunque el embarazo se ha considerado tradicionalmente como un periodo de relativo "bienestar" psíquico, sí parece de-mostrado que el puerperio es un período de especial incidencia de aparición de la patología psíquica. Así, aclaramos que el embarazo no es un estado protector para la salud mental de la mujer. está sujeto a cambios físicos, hormonales, emocionales y socioculturales que pue-den afectar a la dinámica familiar, al patrón de sueño y en consecuencia al estado-rrollar un trastorno mental en el postparto, conseguiríamos adelantar mucho en la prevención del desarrollo de patología psíquica perinatal tan sólo con prestar un mínimo seguimiento y atención a aquellas mujeres embarazadas que tengan ante-cedentes personales o familiares de problemas psiquiátricos, que carezcan de apo-yo psicosocial o que sobrelleven acontecimientos estresantes. Teniendo en cuenta que las patologías mentales son las enfermedades más frecuentes en esta etapa, un adecuado abordaje en el período perinatal podría causar un menor impacto nega-y disminuiría la morbilidad materna (1). La Psiquiatría Perinatal es un área nueva de conocimiento desarrollada en trastornos psiquiátricos durante el embarazo, la lactancia y el puerperio. Actual-mente la salud mental perinatal se puede decir que está ignorada en nuestro medio aunque presente elevada prevalencia y morbilidad además de riesgo de mortalidad como suicidio e infanticidio. Conocemos que el 20% de las mujeres embarazadas sufre alguna sintomatología emocional o trastorno psiquiátrico (2).

Executive Summary
In Canada, 20% of women and 10% of men suffer from perinatal mental illness; rates during the COVID-19 global pandemic have doubled. Unlike the United Kingdom, Australia, and many parts of the United States, Canada does not have a comprehensive national strategy, mandate, or directive to guide how health care practitioners should assess, diagnosis, treat, or provide follow-up to individuals suffering from perinatal mood and anxiety disorders (PMADs) – a spectrum of mental health disorders that can affect an individual from conception to 12 months after birth. The adverse outcomes, both acute and long-term, of PMADs for parents, their children, and families is well known. Consequences of untreated postpartum mood disturbances can include prolonged maternal depression, paternal depression, partner relationship dissatisfaction and conflict, impaired parental-infant interactions and attachment, risk for impaired cognitive or psychosocial development for the child, and in extreme situations, maternal suicide or infanticide. Programs and policies have not kept up with best practices, research, or the overarching science. Services currently available to those experiencing PMADs in Canada are largely inadequate and issues have been magnified during COVID-19. Addressing the psychosocial needs of families to enhance ongoing mental, maternal/child health disparities is a major public health issue.
For these reasons, we, the Canadian Perinatal Mental Health Collaborative (CPMHC), an advocacy organization, are calling on the federal government to enact a national perinatal mental health strategy that includes mandated universal perinatal mental health screening and timely access to treatment among the recommendations listed in this report. The CPMHC is comprised of two founders, over 40 National Committee members (health care practitioners, researchers, and individuals with lived experience) representing all provinces and territories, and Social Media Ambassadors who disseminate campaigns and messages to the Canadian public.
We formed the CPMHC in 2019 and our work gained momentum in January 2020 with the commencement of the #ThisIsMyStory campaign in conjunction with Bell Let’s Talk Day. Followers were asked to submit personal stories surrounding their struggles with mental illness in the perinatal period. Next on the agenda for the CPMHC was the #NowMoreThanEver campaign for World Maternal Mental Health Day (celebrated the first Wednesday in May each year). Individuals with lived experience, dignitaries, politicians, mayors, celebrities and agencies submitted videos of why they felt a national perinatal mental health strategy was needed now more than ever. A compilation video lives on our website (www.cpmhc.ca). This campaign was followed by the submission of an e-petition to the House of Commons for the creation of a national strategy, sponsored and tabled by MP Heather McPherson of Edmonton-Strathcona.
The CPMHC is persisting with our efforts to co-create a national strategy for perinatal mental health care. With a goal to learn about screening and treatment practices across Canada to identify gaps as well as what’s working in different jurisdictions, the CPMHC created a first-of-its-kind national online survey (reviewed and approved by the Conjoint Faculties Research Ethics Board [CFREB] at the University of Calgary) to understand the state of perinatal mental health care in Canada. Four hundred and thirty-five health care practitioners participated. Top findings and the voices of those surveyed are included throughout this report. Critical findings include:
 95.8% of health care practitioners believe that perinatal mental health services are insufficient in Canada.
7
 87% of health care practitioners in Canada do not have mandated screening for perinatal mental illness at their workplace.
 When people are screened and have symptoms indicative of needing intervention, 27% of health care practitioners indicated that patients were able to access their referral within a month, 31% waited between 1-2 months, while 42% had to wait for >2 months for access.
 Perinatal mental health services differ across health regions. More than half of health care practitioners surveyed (57.3%) reported that they have not received specialized training in PMADs or were unsure if they received specialized training.
 87% of practitioners believe people from diverse backgrounds encounter barriers to accessing perinatal services. These include language, cultural, and cost barriers.
 69% of practitioners reported that COVID-19 has complicated access to care, including reduced in-person visits and overall services.
The survey findings underscore a critical need for a national perinatal mental health strategy to address gaps in screening and treatment and are the basis of recommendations in this report. All recommendations have been structured around four pillars of the socio-ecological health care model:
1. Policy
2. Screening
3. Treatment
4. Follow-up
Health care practitioners should integrate screening for perinatal mental illness into routine practice while structural changes are required to ensure accessible and culturally safe treatment of people experiencing perinatal mental illness across Canada.
The CPMHC is requesting a meeting with Minister of Health, the Honourable Patty Hajdu, to discuss our recommendations and how we can work together to create a national perinatal mental health strategy that leaves no one behind.
Enough talk. It’s time for action!

In this article, the social economic practices related to perinatal death, based on Rando's model of complicated mourning and on an analysis of interactions with social institutions identified in the literature as relevant to perinatal death, are examined. Data are reported from semistructured interviews with 22 individuals who lost children to perinatal death. Parents' stories indicate that they were not provided with material social supports that normally would be provided to individuals in the case of a "real" birth or death. Family and community gestures, workplace measures, and medical and legal supports were either discouraged or actively withheld. This lack of financial and material support creates an informal social economy of perinatal death that conveys clear messages to parents regarding their rights and claims to support. It is evident that these practices contribute to feelings of nonlegitimacy and to complicated mourning.

Variation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19 439 late gestation (28 weeks or more) stillbirths could have been avoided in 2015. The proportion of unexplained stillbirths is high and can be addressed through improvements in data collection, investigation, and classification, and with a better understanding of causal pathways. Substandard care contributes to 20–30% of all stillbirths and the contribution is even higher for late gestation intrapartum stillbirths. National perinatal mortality audit programmes need to be implemented in all high-income countries. The need to reduce stigma and fatalism related to stillbirth and to improve bereavement care are also clear, persisting priorities for action. In high-income countries, a woman living under adverse socioeconomic circumstances has twice the risk of having a stillborn child when compared to her more advantaged counterparts. Programmes at community and country level need to improve health in disadvantaged families to address these inequities.

Objective: To propose a phylogenetic significance to the Moro reflex which remains unexplained since its publication in 1918 because both hands are free at the end of the gesture. Method: Among the 75 videos of healthy term newborns we have filmed in a research project on antenatal education to parenthood, we describe a sequence that clearly showed the successive movements of the Moro reflex and we report the occurrence of this reflex in the videos that were recorded from Time 0 of birth defined as the moment that lies between the birth of the thorax and the pelvis of the infant. Results: The selected sequence showed the following succession of the newborn's actions: quick extension-adduction of both arms, the orientation of the body, head and eyes towards a human person, and full extension-abduction of both arms with spreading of the fingers, crying and a distressed face. There were 13 Moro reflexes between 2 and 14 s from Time 0 of birth. We found a significant association between the occurrence of the Moro reflex and the placement of the newborn at birth in supine position on the mother's abdomen (p = 0.002). Discussion: The quick extension-adduction of both arms which started the sequence may be considered as a startle reflex controlled by the neural fear system and the arm extension-adduction which followed as a Moro reflex. The characteristics of all Moro reflexes were those of ritualization: amplitude, duration, stereotype of the gestures. This evolutionary process turns a physiological behavior, grasping in this case, to a non-verbal communicative behavior whose meaning is a request to be picked up in the arms. The gestures associated with the Moro reflex: crying and orientation of the body, head, and eyes towards a human person, are gestures of intention to communicate which support our hypothesis. The neural mechanism of the Moro reaction probably involves both the fear and the separation-distress systems. Conclusion: This paper proposes for the first time a phylogenetic significance to the Moro reflex: a ritualized behavior of nonverbal communication. Professionals should avoid stimulating the newborns' fear system by unnecessarily triggering Moro reflexes. Antenatal education should teach parents to respond to the Moro reflexes of their newborn infant by picking her up in their arms with mother talk.

Wang Simeng. 2022. "L'émergence d'un nouveau marché autour de la santé périnatale à destination des femmes d'origine chinoise à Paris. Réseaux de yuesao (matrones) développés aux frontières entre médecine chinoise et médecine clinique occidentale." in Migrations. Une chance pour le système de santé ? (Ré)humaniser le soin.  Paris, Éditions Doin, p. 39-46.

This article, after introducing the sandplay© method developed by Dora Kalff, explores the images seen in the work of sandplay© clients that may depict birth and/or prenatal experiences. In contrast to other modalities that employ sand trays, the Kalfian method relies on the power of the medium; sand, water, a collection of miniatures, and a tray of specific dimensions, to evoke a process within the client that is not dependent upon interpretation for healing. Case study examples are used to amplify some of the symbols that portray natalistic themes.