BABIES DON'T FEEL PAIN: A CENTURY OF DENIAL IN MEDICINE

David B. Chamberlain, Ph.D.

Presented at The Second International Symposium on Circumcision, San Francisco, California, May 2, 1991.


Abstract

During the 20th Century, when medicine rose to dominate childbirth in developed countries, it brought with it a denial of infant pain based on ancient prejudices and 'scientific' dogmas that can no longer be supported. The painful collision of babies with doctors continues today in neonatology, infant surgery without anesthetic, aggressive obstetrics and genital modification of newborn males. This presentation includes an historical review of empirical findings on infant pain, some the reasons for physicians' indifference, and speculations about the negative consequences of violence to infants.
Introduction

Babies have had a difficult time getting us to accept them as real people with real feelings having real experiences. Deep prejudices have shadowed them for centuries: babies were sub-human, prehuman, or as Luis de Granada, a 16th- century authority put it, "a lower animal in human form."

In the Age of Science, babies have not necessarily fared better. It may shock you to consider how many ways they have fared worse. In the last hundred years, scientific authorities robbed babies of their cries by calling them "random sound;" robbed them of their smiles by calling them "muscle spasms" or "gas;" robbed them of their memories by calling them "fantasies" and robbed them of their pain by calling it a "reflex."

In this paper, I reflect on the painful impact of medicine on infants over the last century. This is not an easy story to tell. It has been a century of discovery and denial, of promise and disillusionment, and the story still has a very uncertain ending.

In the 20th Century, infants have had a head-on collision with physicians, typically male physicians. Before this time, they always found themselves in the hands of women: mothers, grandmothers, aunts, and midwives. In the collision, infant senses, emotions, and cognitions were generally ignored. Over the years, doctors paid increasing attention to the pain of mothers but not to the pain of infants. Actually birth become more painful for infants. We must try to understand why.

Experiments with Infant Pain

Against a back of general (scientific) ignorance of infant behavior, experiments were undertaken as early as 1917 at Johns Hopkins University to observe newborn tears, smiles, reactions to having blood drawn, infections lanced, and to a series of pin-pricks on the wrist during sleep.1 In these experiments (the first of many), infants reacted defensively. When blood was taken from the big toe, the opposite foot would go up at once with a pushing motion against the other ankle. Lancing produced exaggerated crying, and pin-pricks during sleep roused half the babies to move the hand and forearm. Rough cleaning of the back and head to remove vernix provoked vigorous battling movements of the hands, frantic efforts to crawl away, and angry crying. Psychologist Mary Blanton concluded:

The reflex and instinctive equipment of the child at birth is more complex and advanced than has hitherto been thought.2

This line of investigation continued in a series of experiments 3,4,5 at Northwestern University and Chicago's Lying-In Hospital in which newborns were stuck with needles on the cheeks, thighs, and calves. Virtually all infants reacted during the first hours and first day after birth, but the trend, the researchers noted, was toward more reaction to less stimulation from day one through day twelve. As a physiologic finding, this suggested that, at birth, newborns were not very sensitive, but became so gradually. However, they failed to tell us (and apparently overlooked the possible consequences) that all the mothers had received anesthetic drugs during labor and delivery! For the missing information, we are indebted to psychologist Daphne Maurer.6

The Shermans discovered infants would cry in reaction to hunger, to being dropped two to three feet (and caught), to having their heads restrained with firm pressure, or to someone pressing on their chins for 30 seconds.7,8 Babies tried to escape and made defensive movements of the arms and legs, including striking at the object to push it away. Today, we would see these behaviors as "self-management," an example of "kinesthetic intelligence," but in those days, experts were arguing about whether the head or tail end of a human baby was more sensitive9

Subsequent studies to learn how well infants could feel were directed at the big toe,10 calf,11 head, trunk, upper and lower extremities. Especially influential was an ambitious study at Myrtle McGraw12 at Columbia University and The Babies' Hospital, New York, using pin pricks to reveal the progressive maturation of nerves. Seventy-five infants were stimulated with a blunt sterile safety pin at intervals from birth to four years, and their responses duly recorded (half were recorded on motion picture film). Ten pricks in each area ensured that reactions were sufficiently "intense." (We are not told if the mothers had received anesthetics.)

McGraw reported that some infants a few hours or days old showed no response to pin prick. The usual response, she said, "consists of diffuse bodily movements accompanied by crying, and possibly a local reflex." In spite of the fact that these babies did react, did cry, and did try to withdraw their limbs, Dr. McGraw concluded there was only limited sensitivity to pain and labeled the first week to ten days a period of "hypesthesia" (abnormally weak sense of pain, heat, cold, or touch.) Her reference to "a local reflex" reflected the common medical view that reactions were mechanical and had not mental or emotional importance. In the discussion section of her paper, she reveals the belief behind the interpretations:

Even when there is sensitivity is it reasonable to assume that neural mediation does not extend above the level of the thalamus. 13

To physicians, McGraw's work seemed thoroughly scientific and justified the continuation of painful encounters between physicians and newborns. In retrospect, the conclusion that infants were somehow not yet sensitive to pain was a prejudiced interpretation, which fit comfortably into the traditional view expressed in medical journals reaching back into the 19th Century.14,15 In recent research, newborns and older babies pinched on the arm reacted instantly to the pain:16 No suggestion of "hypesthesia." There were more pin-prick experiments. In 1974, in ignorance of the experiments already performed Rich tested 124 full-term babies to determine the "normal response" to a succession of pin pricks around the knee. They concluded that: "The normal response is movement of the upper and lower limbs usually accompanied by grimace and/or cry."17

All infants demonstrated the "complete" response after six or fewer pin pricks.18

A different method for studying infant pain was to run water of different temperatures through cylinders attached to the baby's abdomen, leg, or forehead while filming their reactions as the water was made hotter or colder. This line of research began in Europe in 1873 and was taken up in America by Pratt, Nelson & Sun at Ohio State University19 and by Crudden at the University of Michigan Hospital in 1937.20 Babies reacted violently, especially to cold water. Crudden found that any deviation from normal body temperature produced immediate respiratory and circulation changes in all subjects: No sign of "hypesthesia" here either.

Do Babies Really Feel Pain?

Do babies feel pain? I certainly think they do, but, to find out, we should not have stuck them with pins. there are other objective indications of pain.

1. Crying. It seems perfectly obvious now, but for a long time, experts were informing the public that infants cries were only "random" sounds, not genuine communications. It took a quarter century of cry research to prove otherwise.21 Cries are not only meaningful signals, but often compelling ones. They increase in intensity with degrees of pain. Spectrographic studies that reduce sound to an elaborate visual portrait show just how varied and complex cry language is.22 Acoustic studies show that changes in pitch, temporal patterning, and harmonic structure also reflect the degree of pain and urgency. For example, in a thorough study of cries during circumcision, acoustic features precisely reflected the degree of invasiveness of the surgery.23

Parents present at circumcision (a rarity) have recalled how their babies cried. One father, present in the delivery room told me of his great surprise when the obstetrician proceeded to circumcise this boy at delivery. Having been quiet through the entire birth, the boy proceeded to protest loudly about the circumcision! A Jewish father, reflecting on this boy's circumcision on the eighth day, said it was the saddest occurrence of his babyhood: the boy cried more that afternoon, he said, than anytime in his whole first year.

2. Facial expressions. Second, the pain that babies feel is clearly expressed on their faces.24 Brows bulge, crease, and furrow. Eyes squeeze shut: bulging of the fatty pads about the eyes is pronounced. There is a nasolabial furrow that runs down and outwards from the corners of the lip. Lips purse, the mouth opens wide, the tongue is taut, and the chin quivers. This look on a human face of any age communicates pain. Why do we doubt that it means the same on the face of a baby?

3. Body movement. Body language in its larger motor dimensions is also a language that babies share with older humans. In response to pain, babies jerk, pull back, try to escape, swing their arms, use their hands to push away, and frantically scrape one leg against the other to dislodge an offending stimulus in that area. They strike out with their upper extremities and kick with the lower. Fitzgerald and Millard25 made close observations of babies receiving routine heel lancing, a deep wound made in the heel to obtain blood samples. Using calibrated hairs, they gently stroked the corresponding areas in the injured and non-injured heel. Even premature infants showed the same well-defined hypersensitivity to tissue injury that is found in adults.

4. Vital signs. Fourth, we can see how baby pain is revealed by changed in vital signs and blood chemistry. Pain causes increased respiration. Babies hold their breath and release it in piercing cries. Researchers have observed infant heart rates increase 50 beats per minute and peak above 180 beats per minute.26,27,28 In a study to compare behavioral states of the newborn to those of the fetus, Pillai and James29 discovered that the heart rate during newborn crying was unlike anything seen in prenatal life. This racing heartbeat was unstable, often reaching peaks in excess of 200 bpm, in spite of the fact that baseline heart rates after birth are generally 20-25 bpm lower than they are in utero. These extremely elevated heart rates signal a serious and urgent disturbance.

Serum cortisol is a measure of stress. In painful conditions, adrenals may release cortisol three to four times the baseline.30, 31,32,33 In one study, cortisol levels clearly differentiated between three different surgical techniques of circumcision.34

Under painful conditions, tissue and blood oxygen levels drop.35

5. Neurobehavioral assessments. Further consequences of infant pain can be seen in neurobehavioral assessments. Babies who have been subjected to pain may have difficulty quieting themselves. Following circumcision, the normal progression of sleep cycles is reversed with immediate and prolonged escape into Non-REM sleep.36 After circumcision, babies withdraw, change their social interactions with their mothers, and modify their motor behavior.37

Als, Lester, and Tonic38 developed an Assessment of Preterm Infants' Behavior, which includes a list of infant behaviors indicating stress and defense. Behaviors indicating pain include seizuring, tremoring, spitting up, trunk arching, finger splaying, fisting, squirming, inconsolability, and restlessness.

6. Memory. Finally, we know that newborns feel pain because they sometimes remember and speak of painful experiences as soon as they acquire sufficient language.39 At age two, my granddaughter, talking about her birth, asked her parents, "Why did they poke me with a thing?" Her mother asked, "What thing?" "Like a pencil," she said, "they hurted me." She was probably referring to heel lancing, done routinely in American hospitals at birth. Various studies have shown that lancing is always painful.40,41,41 Other such spontaneous memories of birth pain have surfaced, as I have shown by the collection of stories in chapter seven of my book, Babies Remember Birth.43

Adults also remember, although reports are rare. Three men have told me they have always remembered their circumcision in infancy. Another man, Keith, of Dallas, Texas, remembers that he was born with an open abdomen. He says he has always remembered that surgery and the emotions he felt at the time.

We may not like to think babies feel pain, but they do.

Birth Has Become More Painful For Babies

Ironically, in the hands of 20th-century physicians, birth itself has become more painful for babies. Generally, doctors have not been concerned about babies' pain. They have been more concerned about fetal distress (heart rate fluctuations signaling distress) than about neonatal distress.

1. The pain of hospital birth. In the last half century, hospital birth has become the standard birth for the majority of Americans. From a baby's point of view, it is a new type of childbirth characterized by a series of painful routines surely not designed with sentient babies in mind. Sources of pain include: scalp wounds for electronic monitoring and blood samples during labor, forceps extraction (made more frequent now by epidural anesthetics), extreme spacial disorientations, being held upside down by the heels, frigid scales and utensils in a room 20 degrees lower than the womb, bright lights, noise, heel lancing, vitamin injections, astringent eye medications, irritating wiping and washing, sudden separation from their mothers, and banishment to a nursery of crying babies, all of it distinctly painful and upsetting and a flagrant violation of the baby's senses. Obstetricians defend all these practices, calling them necessary and "the best of care."

2. Pain in the womb. Even prior to birth, conditions exist which can provoke crying. When air is available to the fetal larynx, it is possible to hear a cry. "Squalling in the womb" (known as vagitus uterinus) is a dramatic signal of fetal pain, rare but well documented over many years.44,45,46 Virtually all modern cases of fetal crying are subsequent to obstetrical manipulation: tests, versions, deliberate rupture of the amniotic sac, and attachment of scalp electrodes or taking scalp blood while the baby is still in the birth canal. The fact that 20% of these squalling babies die is testimony to the meaning and the urgency of their cries.47

3. Pain of Neonatal Intensive Care. Premature and dangerously ill newborns face pain and peril trying to complete gestation in a neonatal intensive care unit.43,49,50,51 For a comprehensive review of the many stresses babies face in this man-made womb, see Gottfried and Gaiter, 1985.52

Pain is a way of life as babies are tied or immobilized while breathing tubes, suction tubes, and feeding tubes are pushed down their throats.53 Tubes, needles, and wires are constantly stuck into them; their delicate skin is easily burned with alcohol prior to venipuncture or accidentally pulled off when adhesive monitor pads are removed.54,55 The need for gentle and maternal interactions with the babies is only partly met.56,57,58 Psychological strategies and principles of care, urgently needed in this intense, technological environment, are slowly making an appearance.59,60,61

NICU graduates are not necessarily healthy. Mortality and morbidity are high. They suffer emotionally,62 cognitively,63 and in their neuromotor development.64 Life in a neonatal intensive care unit is a mixed blessing,65 and presents agonizing problems of public policy and medical ethics.66

4. Pain of Surgery Without Anesthesia. Hospitalized newborns, from preemies to babies up to 18 months of age, have been routinely operated upon without benefit of pain-killing anesthesia. This has been the practice for decades but was unknown to the general public until 1985 when some parents discovered that their seriously ill premature babies had suffered major surgery without benefit of anesthesia.67,68,69,70,71,72 Up to this time, babies were typically given a form of curare to paralyze their muscles for surgery, making it impossible for them to lift a finger or make a sound of protest!

Jill Lawson reported that her premature Baby, Jeffrey, had holes cut in both sides of his neck, another in his right chest, an incision from his breastbone around to his backbone, his ribs pried apart, and an extra artery near his heart tied off. Another hole was cut in his left side for a chest tube, all of this while he was awake but paralyzed! The anesthesiologist who presided said, "It has never been shown that premature babies have pain."73

Mrs. Lawson was describing the most common surgery done on premature babies, thoracotomy for litigation of the patent ductus arteriosus, which experts taught could be "safely accomplished with oxygen and pancuronium as the sole agents.74 After the parents told their story with the help of nation-wide television, radio, and print media, the ethics of these practices was seriously discussed for the first time.75,76,77,78,79 Resisting change, some doctors continued to argue that "following major operations, most babies sleep," and that "all we need to do is feed them..."80

Surveys taken of policies and practices of infant surgery in the United Kingdom and the United States revealed ambivalence about whether infants really needed anesthesia or would be endangered by it.81,82 Although some hospitals reported twenty years of successful use of anesthesia with infants,83 surveys of common practice revealed infrequent use of anesthesia, under-utilization of anesthesia, and the lack of policies on the subject.84,85

Key medical objections to infant anesthesia - that it was (a) unnecessary and (b) dangerous - were resolved by the brilliant research of Kanwal Anand and colleagues at Oxford from 1985 to 1987. Making precise measurements of infant reactions to surgery, they proved that the babies experienced pain, needed and tolerated anesthesia well, and had probably been dying of metabolic and endocrine shock following unanesthetized operations.86,87,88

When these findings arrived in the midst of the parent rebellion, official bodies of physicians began to acknowledge the need for change and promised to five neonates the same consideration in surgery as they gave to other patients,89 ending 140 years of discrimination. This was a milestone, but not a guarantee. We have no way to predict just how many doctors and hospitals actually follow these policies. Historically, announcement of new policy by a guild has not always affected the practice of individual members.90

The Selling of Circumcision

Circumcision has been a scandal for centuries, but like the scandal of neonatal surgery without anesthesia, it is a particular scandal of the 20th Century. Nowhere on earth has the sheer number of suffering infants been greater than in the United States where generations of newborn boys have been routinely circumcised without anesthesia. Over the last three decades, the rate has fallen from over 90% (an incredibly large social experiment) to around 60%, affecting over one million baby boys per year.

Apparently, this sexual rite originated some 4,000 years ago as a tribal and religious symbol in Semitic cultures. However, psychohistorian Lloyd DeMause91 sees circumcision as only one of numerous acts of genital mutilation and violence perpetrated on infants and children in virtually every culture since the earliest times. Because it involves sexual mutilation in the family circle, he classifies it as incest and identifies it as an adult perversion.

Others believe that circumcision is a violation of the United Nations Convention on the Rights of the Child, Articles 19 and 37, which call for protection from physical injury and abuse, torture and cruel treatment, and from harmful traditional practices.24 The treaty went into effect in September 1990.

Ironically, it was modern obstetricians who gave the practice new status, sanctifying it as a "medical" procedure. Thus legitimized, circumcision became all but universal in many Western countries, a trend that has taken a long time to reverse. In Australia, where doctors have taken an official stand against it, the rate has fallen below 25%. In England, medical warnings92 helped to bring the percentage down to single digits.

A century ago, the physician Remondino made an evangelistic appeal for circumcision, calling the prepuce "a maligned influence causing all manner of ills, unfitting a man for marriage or business and likely to land him in jail or a lunatic asylum."93

According to him, "...circumcision is like a substantial and well-secured life annuity; every year of life draw the benefit...Parents cannot make a better investment for their little boys, as it assures them better health, greater capacity for labor, longer life, less nervousness, sickness, loss of time, and less doctors bills..."94

Alleged dangers of the intact foreskin, listed by Clifford in 1893,95 included penile irritation, phimosis, interference with urination, nocturnal incontinence, hernia or prolapse of the rectum (from a tight foreskin!), syphilis, cancer, hysteria, epilepsy, chorea, erotic stimulation, and masturbation.

In modern times, dire warnings are still clothed in medical language: the dangers of the foreskin now include contracting sexually transmitted diseases, urinary tract infection, and penile cancer. Not one of these conditions is caused by the foreskin or cured by circumcision. Male urinary tract infection is very rare and can be treated medically. The incidence of penile cancer is also rare, even in Japan and Denmark where most men have not been circumcised. Actually, each year more deaths are caused by the complications of circumcision than from cancer of the penis.96 Another "medical" argument for circumcision is that it lowers the rate of cervical cancer in future sexual partners. the fact that nuns have a higher rate of cervical cancer than wives and other sexually-active women makes circumcision irrelevant.

In a comprehensive appraisal, a government epidemiologist97 finds that circumcision lies outside the province of modern surgery, selects patients illogically, neglects the requirement of informed consent, wastes public health funds, disregards pain, has dubious objective, and is too radically done by inappropriate operators.

Actually, no purported medical benefits can possibly justify the routine mutilation of baby boys. For other voices of reason on the subject, see Winberg et al., 1989;98 Snyder, 1989;99 Altschul, 1989;100 Romberg, 1985101 and 1989;102 Ritter, 1992.103

A new trend in research and journal publication is encouraging. Recent articles report the precise measurement of stress during circumcision and compare various forms of anesthesia for relief of pain.104.105,106,107 One can see a growing sympathy for the infants, full acceptance of their pain, serious doubt about performing circumcisions, and strong recommendations for pain relief.108,109,110

New in the literature is any consideration of sexual and psychological losses from having been deprived of a sensitive and functional portion of the penis, having been betrayed by mother and father, and the impact of torture shortly after delivery from the womb.111,112

In exploring the extent of physician influence on parental choice for circumcision one survey showed that when the doctor was opposed, the circumcision rate fell to 20%, but when he was in favor, the rate was 100%.113 By contrast, when four pediatricians in Baltimore gave medical information about the "risks and benefits" of circumcision to half the young mothers in an inner city clinic and none to the other half, they were surprised to find that virtually all the mothers in both halves ended up choosing circumcision. They concluded that deep cultural and traditional issues were working against a change in attitude in their group.114

Surveys examining parental motives for requesting circumcision have revealed similar cultural pressures: they care about appearances, yield to pressure from relatives, misunderstand the medical "benefits," and hold a variety of false notions that circumcision is mandated by the hospital, by public health law, or is required for admission into the Armed Forces.115,116 Parents do not usually know their infants will suffer.

If this form of sexual violence to newborns is to end anytime soon, success will probably require one or more of the following: (1) massive consumer education leading to public revolt against a painful ritual with no benefit; (2) application of national and international child abuse statutes to forbid sexual alteration of newborns and any form of infant torture; (3) a requirement that both parents be present to observe and circumcision performed on their babies; or (4) a rebellion of obstetricians themselves, actively opposing circumcision and refusing to perform the operation. Any one of these would go a long way toward ending a century of scandal for both parents and doctors.

Why Such Indifference to Infant Pain?

A look at the literature on infant pain is both discouraging and hopeful. An analysis of the ten most commonly used textbooks in pediatrics117 revealed that pain was a topic virtually ignored. In 15,000 pages of text, they could find only three and a half pages devoted to pain. Noted French obstetrician Frederick Leboyer's bestseller, Birth Without Violence,118 stands practically alone in its concern for the pain babies feel at birth. In my own collection of journal articles dealing with infant pain, I can count only twenty during sixty years from 1920 to 1980. However, in the 1980s alone, I have collected forty-four studies, reflecting a great surge of interest.

We must wonder why there has been such widespread denial of neonatal pain in medicine.

1. Because they were men? Historically, men have been the surgeons and the circumcisers of little babies. Until recently, few physicians were women: even these were trained by male doctors and were obligated to accept masculine doctrines and protocols. In society at large, men have been notoriously violent, comprising at least 90% of all persons arrested for homicide.

Would women perform operations without anesthesia? Nurse anesthetists assist. Jeffrey Lawson's anesthesiologist was a woman. Would mothers circumcise their own sons? It seem unlikely, yet mothers have been willing to let others do so. Further, in many countries of the African continent, mothers participate regularly in female genital mutilation of their daughters. This includes excision of the clitoris (sometimes also the labia) and infibulation, the sewing up of the vaginal opening.119 Mothers describe these brutal surgeries as necessary and harmless (much as physicians have described male circumcision).

Their motivations, like those behind male circumcision, are erroneous: they fear the clitoris would get longer and longer until it was like a penis, they claim that these female parts are ugly; they maintain a woman's external genitalia endanger babies and husbands, and contaminate mother's milk. Sewing up the vaginal opening is used as a seal of virginity, which is a cultural prerequisite for marriage. The World Health Organization is determined to eliminate female genital mutilation, and women's groups have mounted educational campaigns.120

Jill Lawson, one of the leaders of the parents' campaign of the mid-1980s to shield infants from surgical pain, questions why doctors did not react as individuals. In the New England Journal of Medicine, she writes:

I cannot help but wonder how such a situation came to develop...If I had been told by a physician, no matter how senior, that infants don't feel pain, I would never have believe it. What constitutes the difference between my reaction and that of the thousands of physicians who did believe it?121
2. Were they trying to be scientific? Another possible reason for such flagrant indifference was that these men and women were trying to be objective rather than subjective; being objective was considered ideal, but this had unfortunate consequences in the blocking out of unpleasant realities, the blunting and denial of feelings.

Ironically, while cultivating objectivity, these doctors were still unable to accept objective findings when they were made. Why was it so hard for them? Why should doctors have to go to a library to find out if babies feel pain? Why did they not believe what they saw with their own eyes and hear with their own ears? Being already sure that the infant brain was inadequate, they simply dismissed evidence for pain.

Perhaps they were not trying to be scientific so much as they were trying conform.

3. Tradition. Traditional beliefs in the guild of surgeons have indeed had a powerful influence.

One very old belief was that pain is good, necessary, part of healing, a sign of life, and perhaps even sacred. For example, twenty-six years after the first application of ether vapors in surgery, a prominent New York gynecologist rhapsodized: "The baptism of pain and privation has regenerated the individual's whole nature...by the chastening, made but a little lower than the angels."122

In that light, it may not be so surprising that, after the anesthetic properties of ether were demonstrated in 1846, surgeons developed an elaborate calculus to decide who "needed it." As many as a third of amputations were still done without anesthetic! The process of selection was deeply prejudicial. You can guess who got anesthetic and who did not. Among those who did not were blacks, redskins and the Chinese, immigrant Germans and Irish, many soldiers and sailors, the "hardened" urban poor, and "tough" country women. Those who did get anesthetic were the well-off, the well-educated, and the "artistic" urban woman. When it came to infants, surgeons were never sure.

The majority view was penned back in 1848 by Henry Bigelow, writing in one of the first publications of the new American Medical Association. He wrote that babies had "neither the anticipation nor remembrance of suffering, however severe," making anesthesia unnecessary for them. Like most of his colleagues then and since, Bigelow believed the ability to experience pain was related to intelligence, memory, and rationality. Like the lower animals, the very young lacked the mental capacity to suffer.

A view with strong similarities - that babies do not feel pain as we do - was recently asserted again by a developmental psychologist.123 This is reminiscent of an earlier view that Jews or blacks do not feel or do not suffer "as we do." The campaign for infant rights is not over yet.

A fundamental dogma keeping doctors from recognizing infant pain sprang directly for their study of anatomy: the newborn brain was incomplete and unprepared for learning, memory, and meaning. The early brain was thought to be primitive; only the late brain (cerebral cortex) was capable of complex activity, and this part of the brain was not complete by birth. These myths hurt infants badly.

4. Professionals missed the baby as person. Finally, it was the reluctance of both medical and psychological professionals to see the perinatal infant as a self with mind that encouraged continued indifference toward pain.124,125 If babies were not people, their suffering was not meaningful and could be dismissed. If babies could not think, the mortification of the body could proceed. Reluctance to consider the reality of the newborn mind/person apart from the brain is a glaring example of materialism - a person was his or her brain matter. All that mattered was brain matter.

This reigning philosophy not only led to violations of dignity and needless suffering, but to mistaken clinical judgments. When assessing the impace of surgery without anesthesia, for example, physicians saw babies fall asleep after surgery and assumed they were all right. If a pale baby regained color, or if blood presure returned to normal twenty-four hours after surgery, the surgery and the baby must be okay, as if the experience of pain could go away like a rash.

The Chairperson of the Task Force on Circumcision of the American Academy of Pediatrics said of circumcision that "responses are short-lived, lasting only minutes to hours, and there is no evidence of long- term sequelae."126 Missing from this view is any understading of the psychological sequellae of torture. More than a decade before, psychologists had pointed out that the effects of circumcision are so profound that researchers had mistakenly attribute ceratin behaviors to gender when they were probably due to circumcision.127

When babies received anesthesia indirectly via mothers at birth, obstetricians judged the effect of it by superficial observations of how the baby looked, showing no appreciation for invisible phenomena associated with emotions and psyche. It was only after decades of refinement in psychological testing and observation of neonates that the effects could be properly calculated.128,129,130

Obstetricians and pediatricians were likewise naive about the suffering of infants (and mothers) as a result of being routinely separated after delivery,131,132,133 These psychological realities have been further illuminated by psychological trauma, van der Kolk writes:

In infants who are separated from their mothers, changes have been observed in hypothalamic serontonin, adrenal gland catecholamine synthesizing enzymes, plasma cortisol, heart rate, body temperature, and sleep. These changes are not transient or mild, and their persistence suggests that long-term neurobiological alterations underlie the psychological effects of early separation.134

According to van der Kolk, disruptions of attachments during infancy can lead to mental illness featuring, typically, a biophasic protest/despair response correlated with erratic activity of neurotransmitters. This damage may result in panic attacks and cyclical depressions; To van der Kolk, the essence of psychological trauma is the loss of faith in the order and continuity of life and loss of a safe place from which to deal with frightening emotions. The result is a feeling of helplessness.

Others have pointed to circumcision as a breech of trust.135,136 But this concept only has meaning if you consider the baby as a person.

Conclusions and Recommendations

  1. Pain is a universal language that can be understood by its vocal sounds, facial expressions, body movements, respiration, color, and even its crashing metabolism. Babies speak this language as well as anyone. We should listen seriously and react appropriately.

  2. Pain is as real and upsetting to babies as it is to the rest of us. The myth that their pain is not like our pain is ancient, insidious, and harmful. We should reject it.

  3. Pain makes a deep impression; babies are probably more impressionable. than older children and adults. Protecting them from the impact of pain would prevent personal suffering at the beginning of life and the need for psychotherapeutic repairs later.

  4. The earlier an infant is subjected to pain, the greater the potential for harm. Early pains include being born prematurely into a man-made "womb," being born full-term in a man-made delivery room, being subject to any surgery (major or minor), and being circumcised. We must alert the medical community to the psychological hazards of early pain and call for the removal of all man-made pain surrounding birth.

  5. Physicians have made birth routinely painful for newborns, believing that they would not feel, not care, not remember, and not learn from painful experiences. In effect, they denied pain, and they failed to recognize babies as persons.

  6. Obstetrics was constructed on a false psychology, born in the 19th Century and generally indifferent to the mind of the newborn. The question is: Can obstetricians construct anew approach to infants on the foundations of a new psychology of babies who feel, think, learn and remember?

David B. Chamberlain, Ph.D., is a psychologist (Boston University, 1958), author, and President of the Association of Pre- and Perinatal Psychology and Health. His special contributions include original research on the reliability of birth memory (1980), a dozen scholarly papers on the capabilities of unborn and newborn babies, and the popular book for parents, Babies Remember Birth.

REFERENCES

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  2. Ibid.
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