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Int. 1. Psycho-Anal. (1987) 68,453
INFANT OBSERVATION FROM BEFORE BIRTH
ALESSANDRA PIONTELLI, MILAN
INTRODUCTION
My aim in this paper is to present some
preliminary findings from ongoing research on
the extension of infant observation to prenatal
life with the aid of ultrasounds.
Till recently the natural world of the foetus
was regarded as a kind of secret universe
inaccessible to human sight and completely
shielded from the outside by the abdominal and
uterine walls. Information on foetal life was
derived either from prematurely expelled non-
viable human foetuses or from animal ones. In
the last few years the introduction of real-time
ultrasound techniques has opened up to us an
entirely new dimension by making it possible to
visualize and study the behaviour of an
undisturbed foetus in its natural environment.
In this paper I will not enter in detail into the
technique or the physical laws governing
ultrasounds. Adequate expositions can be found
in many specialized papers and books. Although
I think that a good knowledge of these, as well as
a thorough knowledge of maternal and foetal
pathophysiology is required by anyone em-
barking on this type of research, here I will only
sketch a few details so as to make it possible for
the reader unacquainted with this technique to
follow both its advantages and its limits.
Ultrasounds, as their name says, are sound
waves of a particular frequency beyond the
limited range of our hearing capacities (i.e.
above 20 Hz.). Ultrasounds were first used in
marine biology as water is a very good medium
for the transmission of sound waves. Pregnancy
too is a state particularly favourable to the
physical preconditions for an ultrasonic ex-
amination as the foetus is immersed in the
amniotic fluid and its lungs and bowels do not
yet contain air or gas which would interfere with
the transmission of ultrasounds.
Very schematically, during an ultrasono-
graphic examination, sound waves are emitted
by a transducer in contact through a layer of
mineral oil with the abdominal wall of the
mother. These waves, once they hit a particular
target, are reflected back, as in the echo
phenomenon, and through very complex opera-
tions are then amplified and converted into
electricity. All these complicated steps render it
possible to observe on a video a detailed,
moving, bi-dimensional, black and white image
of the particular area which has been the target
of the wave-sounds and this allows the
obstetrician to create a visual image of the foetus
in utero and to follow its motions. All the images
can be recorded contemporaneously on tape.
The image, as I said, is bi-dimensional and
therefore one can only observe one foetal section
at a time. The different parts of the foetal body
can be easily identified and their movements
recognized. Even very small and fine movements
can be visualized provided that they occur in the
plane of the scan. One will probably have to
await the future development of holographic
methods before having the possibility of three-
dimensional real-time images.
Another limitation of ultrasounds is that the
current dimensions of the probes do not permit
us to obtain in late pregnancy an image of the
whole uterus containing the foetus. As pregnancy
progresses beyond the 20th-22nd week, it
becomes impossible to visualize, as in the earlier
weeks, the entire body of the foetus. Therefore
one has to focus on a particular bodily segment
at a time. Training and experience are also
required before an accurate reading of the
images can be achieved. An observer can only be
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454 ALESSANDRA PIONTELLI
disappointed if he thinks he is watching
ultrasounds as one watches a real-life film.
Although very fine and detailed images can be
seen, these are rather more akin to X-rays than
real-life, and one has to get used to them before
being able really to follow in detail and to
appreciate the richness of what is being
displayed. In spite of all these limitations, the
advent of ultrasounds brought about a dramatic
step forward in our knowledge of the physiology
and the pathology of the foetus.
In recent years the general view of the foetus
as a totally passive and dependent creature living
in a state of vegetable-like nirvanic oblivion and
of the uterus as a silent, motionless and totally
secluded place had already been radically
changed. Much research showed the sophistica-
tion of the foetal perceptive and motor
apparatus as well as the increasing complexity of
the mental apparatus and the active foetal
participation in the maintenance of pregnancy
and in determining its final outcome. Long
before birth a foetus can hear, respond to
pressure and touch, swallow and taste, react to
pain, choose its preferential position and also
have some kind of primitive dream experience
and show the beginnings of some form of
learning. It was also shown that all these
activities were not just aimless ones. For instance
swallowing, as well as providing an important
source of nourishment from the amniotic fluid,
is also probably the main regulator of its volume.
Movement is vital for the proper development of
foetal bones and joints, and sensory experiences,
including those derived from movement, are
vital for the development of its brain etc. The
uterus too is not considered any more as a silent
and totally secluded place. Maternal borborigmi,
maternal voice, heart beats and bruits of blood
in the great vessel supplying the uterus and the
placenta, all can reach and be heard by the
foetus. Nor does the uterus separate the foetus
completely from the outside world. Apart from
sounds, other influences can be felt directly by
the foetus, such as maternal emotions, through
changes in arterial pressure or through sub-
stances such as cathecolamines which can cross
the placental barrier. Other substances from the
ouside can also cross such a barrier, for example
drinking and smoking or the ingestion of drugs.
But till the advent of ultrasounds the womb still
represented a rather impenetrable obstacle to the
direct study of foetal life in its natural
environment.
From the beginning, ultrasounds have been
widely used in studying both the physiology and
the pathology of the foetus and have found
many practical applications such as the detection
of malformations, the determination of foetal
age, of the growth characteristics of the foetus
and of placental position and maturity etc.
The more relevant use and interest of
ultrasounds for the psychoanalyst are found in
the study of foetal movements and foetal
responses to its environment. Ultrasounds have
shown that motor activity of the foetus is already
present long before mothers can perceive any
sign of it. They have also shown that such
activity is already very complex and sophisticated
from the early stages. Several authors have
subsequently described and classified the various
types of movements of the foetus as well as the
chronological order of their time of onset
(Timor-Tritsch et al., 1976; Birnholz et al., 1978;
De Vries et al., 1981; Ianniruberto & Tajani,
1981). All these studies demonstrated a suc-
cessive development from simple movements
involving the whole foetal body to more complex
ones. Smooth 'vermicular' movements of the
foetal body were seen as early as the sixth to
seventh week of post-menstrual age. After the
tenth week of pregnancy, active locomotion of
the foetus was noted to be present. Swallowing,
sucking and breathing were observed at 14
weeks' gestation. All the movements to be seen
in the term foetuses were observed already to be
present at the age of 15 weeks (De Vries et al.,
1981). Some movements such as 'vermicular' or
jerky movements were observed only during
earlier periods of gestation and their re-
appearance at a later date always meant a
regression to earlier stages and the presence of
some kind of pathology and of danger for the
foetus. Other authors have also tried to define
and distinguish different states in the foetus such
as quiescence, waking and sleep (Timor-Tritsch
et al., 1978; De Vries et al., 1982). So far none of
this research has focused on the global
behaviour of an individual foetus and on its
relationship to its prenatal environment.
As with infant research, babies can be studied
in many different ways. They can be studied in
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INFANT OBSERVATION FROM BEFORE BIRTH
isolation and their different movements can be
analysed and catalogued, their responses can be
timed. their smiles quantified etc. Or else one can
look at a baby as a whole and, since none of us is
born in isolation. one can observe its de-
velopment within its environment. Infant
observation introduced a whole new way of
looking at babies and of seeing them within their
natural environment while observing their
development in the context of the nascent
relationships with the human objects populating
their world. Even little gestures were postulated
to have a meaning within the context of such
relationships and were seen to have a mental
meaning for the baby. A smile was not just a
smile, sleeping was not just recovering and
feeding taking in calories. Each of these had also
a more complex meaning. Infant observation
was in turn based on the light shed by Melanie
Klein on the complexities of the mental and
emotional life of the newborn which she saw as
operative from the start.
My personal interest in foetal life, apart from
being part of a general and worldwide curiosity
probably present in mankind since ancient times,
stemmed also from several phenomena I
encountered in my clinical work. In working
with very young children I was struck by the
frequency and concreteness of their fantasies on
life before birth. For some more withdrawn and
regressed children these seemed not to be just
fantasies, but somehow for them living in the
past and reliving their past became a permanent
mode of being. The same seemed to apply to
some psychotic or borderline psychotic adult
patients whom I had the opportunity to treat. I
was also struck by the fact that the degree and
severity of withdrawal and regression in several
young children didn't seem to match the
characteristics of their post-natal environment.
Actually the two most regressed and severely
withdrawn young children I ever treated seemed
to have rather warm and devoted parents.
Parallel to my working as an analyst I also had
the opportunity of observing several babies and
following their development, and I was struck by
the differences in their 'character' at birth and by
the difference in their readiness and capacity to
be able to live mentally in the outside world. If
I Other research on foetal movement was being carried out at the Hospital where I was working at the time.
455
an already weak capacity to live outside matched
with a 'non-facilitating' not 'geed-enough'
environment, this could have the tragic effects I
described in my book Backwards in Time
(Piontelli, 1986).
All this led me to ask myself the question
many times: what had happened or what
happens before? Why are some children born
more open and more strong? Why for some of
them has one the feeling that they are already
past hope at birth? Why cannot some children
forget their past? Why do some others have to go
back to it when life in the outside becomes too
harsh? We come here to the old query: is it
nature or is it nurture? Is it genetic or is it
environmental? In my research I do not pretend
to give any universal answers to all these
questions, but I hope I will be able to show how a
whole new universe is now there before us almost
totally unknown and unexplored.
RESEARCH
When I started observing foetuses with
ultrasounds I actually didn't know exactly what
I was looking for. I only had in mind extending
infant observation to life before birth and to
follow some foetuses and mothers before and
after birth. I wanted to see if there was some kind
of continuity between the two states and, if so,
what kind. But I had no idea of what one could
actually observe and expect to find. As I
mentioned before, first it took me some time to
get used to the images I was seeing on the screen
and to be able to acquire sufficient confidence in
my capacity to decode what was being shown on
the screen. At first, therefore, I sat through many
observations as a simple spectator in order both
to get acquainted with the visual images and to
form a better idea of what one could aim to look
for. J What struck me during this time (about one
year of almost weekly observations of several
pregnancies), was first of all the richness and the
complexity of movements one could observe
since the early stages. Long before mothers
could perceive any of these movements, their
babies could suck, stretch, scratch, yawn, rub
their hands and their feet etc. I was also struck,
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456 ALESSANDRA PIONTELLI
particularly in the earlier stages, by the freedom
of movement each foetus could enjoy in the
amniotic fluid. With the impact of gravity at
birth this freedom seems to be lost at least for a
while, and in this respect a baby seems a much
more impotent creature than its predecessor.
As my experience widened I was also more
and more struck by the individuality of
movement of each foetus and by their
preferential postures, attitudes and reactions.
Each of them seemed to have a different
personality. Each of them also related differently
to its environment and to its various components.
This was evident not only from what I was
observing on the screen, but also from the
frequent comments I could hear from the
obstetricians and from several mothers and their
companions. All the observations were inter-
spersed with remarks like 'he is a nervous type',
'this one will become a dancer', 'he is very calm',
'she is a sort of reflective type', 'she has a good
character', or 'he is using the placenta as a
pillow' or 'look how badly he treats the cord'.
Somehow they all took it for granted that one
could read from different types of attitudes and
activities some indication of the child's future
character. More or less the same comments
seemed to be repeated for each foetus each time.
At this stage I decided therefore to focus on a
few mothers and their foetuses and to follow
them throughout pregnancy and during the first
year of the baby's life to see if what had been an
impression of an existence of some early makers
of character could then find a confirmation in
the subsequent development of the child after
birth. Mothers were selected only on the basis of
their willingness to accept this kind of follow-up.
At first I concentrated on a few single
pregnancies. Now several twin pregnancies are
also under observation.?
The ultrasonographic sessions were usually
started around the 14th-18th week of gestational
age. One observation (see case N.I) was started
at 12 weeks. Subsequently mothers were seen at
monthly intervals and each mother was
subjected to an average of five 5~60 minutes'
ultrasonographic observations. The images were
2 Though twin pregnancies are for several reasons more
difficult and complicated to observe and one should
probably study them only after having become acquainted
with several single ones, I think that they prove to be par-
simultaneously recorded on a videotape.
Mothers were invited to come to the Clinic in the
early afternoon after meals, and the observations
took place in a quiet dark room. Besides the
mother and myself, usually one or two
obstetricians were present. Very often mothers
came accompanied by someone (husband,
mother. aunts, daughters, sisters, friends etc.)
and the companion was also allowed in the
room. Each observation had a strong emotional
undertone, but the very emotional impact that I
had found at first to be a hindrance in decoding
the images of the foetus, now became itself an
important tool of research. As well as the
emotional impact each foetus had made on me, I
tried to record each time also the impact on the
other people present in the room, focusing in
particular on the reactions and behaviour of the
mother and of whoever was accompanying her.
Subsequently I made notes on all these. When-
ever possible I was also present at the delivery
and, if not, I obtained detailed notes from the
obstetricians about it and about the attitude of
the mother and of the baby during the transition
to this world and in the few hours following birth.
The observations then continued at weekly
intervals for the first year of life with the method
of infant observation as described by Bick (1964).
Subsequently periodic follow-ups were planned.
My results so far are still partial and more
time will be required before this work could be
considered more complete. Nothing better than
the account of some observations can give an
idea of the kind of evidence one can expect to
find in this type of observation. I will therefore
report two of them in some detail.
OBSERVATION N. I
Mrs A is a woman in her early thirties, and is a
primipara. She has been married for several
years to a man in his forties. Her pregnancy had
not been planned. She and her husband kept
postponing the decision to have children as they
loved their freedom too much and were afraid of
the kind of commitment a child would entail.
ticularly valuable in the study of individual differences
and/or similarities as well as in the possibility of observing
the different kinds of relationships each pair of twins seems
to show.
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INFANT OBSERVATION FROM BEFORE BIRTH
During a stay in hospital for a series of tests
undertaken in order to discover the possible
causes of her being overweight, no apparent
reasons for it were detected, but Mrs A was
found to be pregnant. As she said, it was a 'messy
start', but she was also pleased that it had
happened. When she first came to the Clinic
accompanied by her husband I was immediately
struck by the aspect of both future parents.
Though she was only 12 weeks pregnant, Mrs A
looked enormous in her wide maternity dress.
She is also a rather tall woman and Mr A, who is
a short man, looked even shorter besides her.
She smiled a lot with a warm smile and always
remained calm and rather silent during the
observation. She breathed regularly and showed
no sign of anxiety or of emotion while watching
the screen rather blankly. Her husband on the
other hand kept dropping rather cynical remarks
about the 'thing' we were describing on the
screen and about our 'fantasy' in decoding and
describing its movements. He kept repeating that
he had no feelings towards the 'thing' and that
anyway all babies were ugly and it took a lot of
imagination to see them as lovely creatures. This
behaviour continued throughout every obser-
vation. Towards the end he only added a list of
ludicrous names to be given to the 'thing' once
born. Yet he always came with his wife and,
under his apparent cynicism, one could detect
more of a wish to be considered a 'tough guy',
rather than real contempt or scorn. This attitude
was probably also increased by the fact that we
were all women in the room.
Mrs A, on the other hand, continued with her
placid, rather detached attitude till the end. She
kept breathing regularly and watching the screen
rather blankly. She smiled at her husband's
remarks and made no comment herself. As her
volume increased, she found breathing more
difficult and towards the end of pregnancy she
began to voice some worries about the delivery
which she feared as an almost inevitably
dangerous event. 'I am too fat ... how can it
come out? .. .' There was no mention of fears for
the baby who seemed still a rather cloudy and
vague figure for her. The delivery was in fact
rather difficult (I was present at the later part of
it). Mrs A spent almost 24 hours in labour.
Though she was induced, dilation was slow while
contractions were frequent and painful. Towards
457
the end Mrs A lost her head and kept screaming
'it won't come out ... help me ... I am going to
die .. .' and was unable to push. A caesarian
seemed inevitable, till a rather high-ranked
obstetrician unknown to me intervened by
applying a vacuum extractor and by literally
jumping in a barbarian way on her stomach and
the baby was finally expelled. The husband, who
was also present at the delivery, lost a little bit of
his usual cynicism and was as pale as a ghost.
When it was over, nobody paid much attention
to the baby, a girl. Mrs A said that she was too
tired even to look at her. Her husband found her
incredibly ugly and left her in the care of a nurse.
During each ultrasonographic observation
Giulia (the name subsequently chosen for the
girl) appeared to be extremely placid, though not
immobile. Most of the time she floated in the
amniotic fluid following the rhythm of her
mother's breathing, as iflulled by it. On a couple
of occasions she was seen to rock herself into
what appeared to be sleep. Mostly she kept her
arms at her sides, but she was also seen with her
hands between her legs or else moving them very
finely while joining them and moving her fingers
with great skill. But the most apparent and
constant movement was, from the start, that of
her tongue. Giulia, in each observation, seemed
almost constantly engaged in playing with it,
moving it in and out of her lips. In the last two
observations she was also seen repeatedly licking
the placenta wildly while stretching her head
backwards and on a couple of occasions her
licking was actually so effective that she
succeeded in pulling a small portion of the
placenta towards herself. On one occasion she
was also seen licking the umbilical cord.
While I was observing Giulia, she gave me the
impression of being of a placid nature, well at
ease in her intra-uterine world, but somehow she
also conveyed the impression of being quite a
sensuous creature, in allowing herself to be
peacefully lulled, in rocking herself to sleep and
particularly in her constant and seemingly
voluptuous use of her tongue.
Giulia's reaction to birth seemed at first a non-
reaction. Her eyes were kept closed and she
looked unperturbed. She cried, clenching her
fists near her face, only when two nurses poked a
small pipe inside her nose and her throat in order
to inhale her secretions. When it was over she
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458 ALESSANDRA PIONTELLI
stopped crying and opened her eyes again,
seeming at ease. She looked around, keeping her
arms at her sides and not moving her legs when
put in contact with the presumably rather cold
surface of some scales. She reacted once again
by crying and clenching her fists but was soon
soothed when picked up and later bathed. Her
expression was again unperturbed, her eyes
open, her arms at her sides and she remained like
that till I left.
When I visited Mrs A in hospital the following
day she still looked rather tired, but was pleased
to see me. She spoke for a while about the
delivery saying repeatedly that Giulia was 'too
comfortable there she didn't want to come
out and let go ' Giulia was also there,
apparently asleep, with her cheek in contact with
her mother's breast. Mrs A tried to force the
nipple in her mouth, but she didn't suck and
didn't react. Then after trying again, Mrs A sat
her up holding her between her legs. Giulia
immediately opened her eyes, wandering with
her gaze. Then she started sucking, her tongue
moving almost continuously in and out of her
mouth. Her mother interpreted this as a sign of
hunger, but when put back at the breast, Giulia
didn't suck and her mother said 'but you are not
sucking it ... you are licking it ... ' Then Mrs A
leaned her with her face against her chest saying
'She loves this position ...' and immediately
Giulia started licking her mother's chest with the
same almost wild motions I had previously
noticed when she licked the placenta. When later
her mother tried again putting her at the breast,
she soon said 'but you are not sucking ... you
are licking! .. .' and her licking continued till I
left.
The next time I went to visit Mrs A at home
and I was impressed both by the great chaos in
the house, with piles of empty bottles and
unemptied ash-trays, and by the amount of food
on display. Rather than a house with a new baby
it felt like a Gargantuan cellar with tins,
spaghetti, biscuits, jam, sauces and salami
everywhere. This time Giulia sucked her tongue
even before opening her eyes, then licked her
blanket and her licking continued throughout.
Her mother told me that she was very voracious,
ate in five minutes and spent the rest of the time
playing with her tongue. She also told me that
Giulia seemed a placid baby who liked looking,
hearing voices and sounds and licking her chest.
What happened in the following months
seemed to form a continuum with what I had
observed before. Giulia continued to be a rather
voracious baby who ate 'in five minutes' and
spent the rest of the time licking her tongue. She
also licked any surface or textile which came into
contact with her face. I saw her licking her
mother's chest, her shoulders, her chin, her arms
and the clothes covering them. The pleasure she
derived from sucking from the breast and the
amount of time she spent in contact with it,
seemed short and less strong than the pleasure
she seemed to derive by licking any of these.
It was only when Giulia was introduced to
solids, when she was about four months old, that
food seemed to become almost an obsession for
her. According to her mother, Giulia now
gulped enormous amounts of paps and was
attracted by anything she saw on her mother's
plate or entering other people's mouths. Each
time I visited Mrs A I was offered coffee, and a
dish full of biscuits always came with it. Each
time Giulia saw the biscuits or noticed the sugar,
she started screaming or stretching her arms
frantically towards it, till eventually she was
given a biscuit and then another one and another
one which she licked and gulped noisily and
voraciously. Not surprisingly she also began to
put on weight and at the age of ten months she
already weighed as much as a child of 2.
Nor did food seem to be the only source of
pleasure for her. Giulia seemed to derive
pleasure from the use of almost all her other
senses. She seemed to find it extremely
pleasurable to let her eyes wander. As her
mother said, 'she loves looking' and her gaze
didn't seem to reflect much curiosity or
enquiring, she seemed rather to have a 'big feast'
with her eyes. Her grandmother's face seemed as
attractive as the sight of her scarf or of her huge
baroque lamp. Her mother told me that Giulia
also 'loved hearing', so much so that she often
left the radio on for her all day long. She
certainly listened with pleasure to the sound of
her mother's or of her grandmother's voice
talking to me. According to her mother, Giulia
went 'wild' whenever she heard the sound of a
man's voice and I am rather inclined to believe
this given the reactions to her grandfather's
talking that I could witness. As her mother said
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INFANT OBSERV A nON FROM BEFORE BIRTH
'She is really a little whore ... she is mad about
men .. .'
A bit later she seemed also to enjoy her own
sounds and at times she could be heard babbling
non-stop and emitting all sorts of sounds while
her mother spoke to me. Giulia seemed also to
love touching and stroking and feeling the
texture, particularly of any soft and velvety
object. Except when it came to food, smell was
probably the less visibly used of her senses.
When she was a bit older Giulia seemed to derive
a sensuous pleasure also from rather mastur-
batory activities such as endlessly rocking
herself. Her grandmother seemed to have well
understood her inclination as she told me that
Giulia, when picked up, loved to have someone's
arm between her legs. Yet Giulia was far from
being dull and when one year old she seemed
more the portrait of a bonne vivante, who seemed
absolutely at ease with her surroundings and was
determined to derive the maximum of pleasure
rather indiscriminately from any source at hand.
Though food still ranked higher-and as her
mother told me, 'I have seen her licking the
floor ...' looking, listening, talking, touching
etc.-all seemed equally pleasurable for her.
As with her senses, her attachment to people
seemed also rather indiscriminate: 1 never saw
her look back at her mother provided someone
else's arms were at hand. As time passed Giulia
became rather skilful in mastering her motor
functions. From the very beginning she showed
that same skill in moving her hands that I had
observed in the womb. She was very soon able to
suck her thumb while at the same time stroking
her hair and her face. She grasped objects readily
and by nine months she was able to crawl. When
ten months old she could stand and by eleven
months she began to take her first steps. Not
surprisingly her locomotion became yet another
aid in her constant hunt for pleasure and for
food. Gurgling too came easily to her and by
eleven months I heard her repeat a few simple
words.
People surrounding Giulia seemed to be either
similar to her or at least inclined to foster her
tendencies. Except for the second observation,
all the following ones took place at Giulia's
grandmother's home (Mrs A's mother). Mrs A
found this more convenient and she said that she
was going to be there anyway on the day we had
459
agreed to meet and resisted any subsequent
attempt to bring her back to her home. There she
said, she could be 'fed and cuddled like a baby'
and surely she was. And her mother, who had
had six children, was only too pleased to adopt
me as well. All her children were female and her
house seemed an eminently feminine universe.
The women, all tall and strongly built,
considered all their equally short men either lazy
or a bit of a nuisance because of their demands
and their interfering with the cleaning of the
house.
Mrs A's mother was a 'Mother', always
dispensing food and gentle opinions on child
rearing, her real 'expertise'. Mrs A behaved, with
her, as a child. Her mother took over with Giulia
and Mrs A didn't seem to mind. Every
observation took place around the table with
biscuits and coffee, with Mrs A eating non-stop
and both her and her mother also talking non-
stop. Giulia soon joined in with her gurgling. In
this respect Mrs A seemed rather similar to
Giulia, though perhaps less enterprising. She
seemed rather addicted to food, and for her and
for her mother talking seemed as pleasurable as
Giulia's licking feasts. Giulia was certainly given
a lot of attention, though of a rather sensuous
and wandering type. Her father, in as far as 1
could tell, seemed to continue either to mock her
or else to keep rather at a distance from her,
leaving all the women to their feminine duties.
Giulia's mother seemed still to live inside a kind
of rather uterine universe which she found too
comfortable and dared not let go. 1 was later
told that even her marriage had been arranged
by her own mother who had known her husband
since he was a child and treated him as a son. It is
not possible for me to tell whether Giulia will
suffer the same fate and will be stuck forever to
food and her licking feasts, or whether her
slightly more enterprising nature will perhaps
one day pull her out of her too comfortable
cocoon.
OBSERVATION N. 2
Mrs B, a woman in her mid-thirties, was very
anxious when she came for the first observation.
This was her third pregnancy and the second one
had ended in stillbirth due to abruptio placentae.
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460 ALESSANDRA PIONTELLI
She was accompanied by her husband and all her
attention was directed towards the placenta, its
insertion, its shape etc. and she kept repeating
the same questions about it throughout the
observation, seeming very little interested in and
aware of her sixteen week old child. Her
husband, a man also in his mid-thirties, sat by
her side and, though rather silently, seemed to
foster her fears. No reassurance seemed enough
to placate her obsessive questioning and her
anxiety that something could happen any time.
The anxiety and the endless repetitive ques-
tioning remained constant features throughout
pregnancy.
Later Mrs B told me that the anxiety was
pervading all her life and that she often woke up
during the night feeling imaginary contractions
and thinking that she was going to 'lose
everything'. In spite of her anxieties, pregnancy
seemed to proceed well. On the second
observation Mrs B came accompanied by her 7-
year-old daughter and both now seemed
obsessed also by another question: sex. Though
one could already tell rather clearly that it was a
boy, the question was repeated over and over
again: What was its sex? Was it a boy or a girl?
Was that the penis? Were those its 'balls'? etc.
and whenever her daughter was present in any
subsequent observation the question of sex
almost prevailed over all else. Very little
attention and space was given otherwise to the
child.
On the other hand, Gianni, the name given to
him later, seemed to do little or nothing at all. He
remained immobile, tightly crouched in a corner
of the womb, with his hands and his arms
screening his eyes and his face, and with his legs
so tightly folded and crossed as also to almost
cover his face. His immobility, though, conveyed
none of the placidity of Giulia's floating, as it
seemed born out of tension, ifnot terror, not out
of peace: with his arms raised above his head
sheltering his eyes and his face, he looked very
much like a figure out of a painting by Munch.
Though Mrs B reported movements during the
day, in all the other following observations (5)
not the tiniest movement was seen and if
anything, in spite of his expanding volume,
Gianni looked even more tightly crouched. Even
the narrow space of the womb seemed to be too
big a space for him. It was always impossible to
see his face, screened as it was by his arms and his
hands. The umbilical cord was often seen
between his arms and legs, but it was impossible
to tell whether he did something with it other
than holding on to it. The only clearly visible
thing continued to be his sex.
When the term approached he hadn't yet
turned and was still tightly crouched in a corner
of the womb in the transversal position. In the
meantime Mrs B's blood pressure was found to
be slightly raised and she was sent into hospital.
Since the child gave no sign of wanting to turn
round and Mrs B's blood pressure continued to
rise, a caesarian was decided upon. I couldn't be
present at the intervention on that day, but the
obstetrician later told me that the child was so
crumpled in a corner of the womb that she had
considerable difficulty in pulling him out, She
said 'he would never have been born'. One of his
feet, due to his position in utero, was found to be
crooked and therefore had to be put in a plaster
for three months. Once she pulled him out the
obstetrician was also struck by his immobility
and by his fixed and sad look. 'He looked old ...
100 years old ... it was somehow frightening to
see the immobility of his face ... '
During the next two months Gianni continued
to be practically immobile. Whenever I saw him,
his arms were kept at his sides, his head was bent
backwards, his eyes were closed and he seemed
immersed in a deep sleep. When his mother put
him at the breast, he sucked slowly, frowning,
with his eyes tightly closed and his arms at his
sides, but he also clung to the breast for hours on
end. As his mother said 'He doesn't want to let
go ... he is using me as a dummy ... he doesn't
care about the rest of me ...' but Gianni,
frowning and tense as he was, didn't seem to
derive much pleasure from the breast, only
perhaps some security, as he seemed to hold on
to it as to a rope. His mother on the other hand,
though apparently resenting it and often saying
'when he grasps it, he kills me ... ' kept feeding
him for hours on end and found the breast so
convenient as it required no effort and seemed to
stop any other request from the child.
Though totally immobile and apparently
asleep, Gianni seemed very sensitive to any kind
of unexpected and sudden noise to which he
reacted each time with a start and a frightened
expression on his face. While feeding him, his
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INFANT OBSERVATION FROM BEFORE BIRTH 461

mother never looked at him and spoke in his push-chair in order to smoke a cigarette,
relentlessly with me. Now that the placenta was a though still immobile, he looked suddenly
problem of the past, her attention and curiosity somewhow more relaxed and often stopped his
shifted to other areas connected with genitality desolate whimpering sound. Mrs B also told me
and sex. She wanted to know all the details of my that the best way to keep him quiet was to go out
gynaecological history and tried to find out for walks with him. 'He loves going out and he
details about the intimate life of each member of soon falls asleep ...'
the obstetric ward. She spoke repeatedly of When Gianni was about five months old, Mrs
abortions and contraception. She seemed to B began to make plans to go back to work. She
know all the details of her friends' pregnancies found a 'young and not very intelligent' baby-
and seemed obsessed by anything even remotely sitter. On the few occasions I saw her, though
connected with reproduction and sex. She often talking non-stop, she seemed gentle and kind to
also presented herself in the guise of a 'sex him. Christmas was also approaching and the
goddess', as when in the first observation after family went away for a short holiday in the
Gianni's birth I saw her walking solemnly with mountains. I was told that Mr B, otherwise very
her bare breasts in a short and transparent busy at work, had looked after him a lot. When
nightie before an astonished obstetric ward. they came back from the holidays, Mrs B went
Apart from sex, and anything related to it, Mrs B back to work. I saw Gianni again-though he
seemed to find any other subject intolerable and was still quite immobile, he looked more relaxed.
suffocating. Mrs B too said that she felt better now that she
Though she certainly liked my presence, she was back at work. 'I feel as if I am breathing
managed to keep me at a distance by regularly again ... he seems better too ... ' and funnily
cancelling my visits every other week. She found enough while she was saying this Gianni let out
it oppressive being at home with her child and two heavy sighs which sounded like relief.
longed to go back to work etc. Gianni too didn't Though his gaze still continued to be rather fixed
seem to thrive on the endless contact with his and vacant, Gianni sometimes looked at me and
mother's breast. When he was about 40 days old, smiled. He also accompanied his mother's
whenever he clung to it while frowning and endless enquiries about gynaecology and sex
closing his eyes he began often to give out a with long constant sounds which reminded me in
prolonged, desolate moaning sound. Then when their tone of the endless talking of the au pair.
he was three months old he began to wake. His main contact with his mother was still the
Though still immobile, he then began to breast and Mrs B continued breast-feeding him
whimper non-stop, with his eyes wide open till he was ten months.
staring fixedly and blankly into space. Mrs B At one year of age Gianni looked rather
always attributed his crying to colics and wind. backward in his development. Though he could
Now that his muscular strength was increased, certainly sit and apparently crawl, he preferred
I saw Gianni at times also bringing his arms near to sit in a corner always holding the same toy
his head and his face very much as I had seen him and almost never moved about. So far I have
before birth. But the most striking feature was heard only sounds and no words. His mother,
still the immobility of his body, his eyes and his now that she has stopped breast-feeding him, is
face. In order to placate him now his mother beginning to treat him a bit as a 'sex-object' and
spent hours walking about with Gianni turned often teases him for his obvious sexual
against her chest while tapping his back incapacity. I have frequently seen her holding
mechanically. Gianni was often ill and he Gianni between her legs while saying laughingly
continued to be so with colds, bronchitis, ear- 'but why can't you stand more erect? ...'
aches, and still had problems with his left foot
and leg. Mrs B, on the other hand, kept saying For reasons of space my report of these
that she couldn't stand being with him all day observations is only sketchy and short and many
and was afraid of 'going mad' if she had to be important elements and details have been left
still stuck at home. Proximity seemed obnoxious out. My descriptions of these children before
for them both. Whenever she put Gianni down their birth has none of the strength of the visual
Copyrighted Material. For use only by StockholmUni. Reproduction prohibited. Usage subject to PEP terms & conditions (see terms.pep-web.org).
462 ALESSANDRA PIONTELLI
images on the screen and I am sure it is difficult
to sound convincing when writing about such
primitive states.
What I hope I have been able to show is the
kind of continuum one can expect to find before
and after birth. Giulia's play with her tongue
seems to date back a long way and her sensuous
attitude is still present today in her constant
search for pleasure and for food. Gianni
certainly behaved very differently from her
inside the womb. He showed none of Giulia's
ease and his upsetting closure, stillness and fixity
seem to be still there at one year of age. A
continuum can also be seen with their
environment-many are the similarities between
these two children and their surroundings.
Giulia's mother is rather similar to her in eating
enormous amounts of food. Everyone around
Giulia seems also to stimulate and to foster her
sensuality. Gianni seems to have been bom-
barded with anxiety and closure since before
birth. His mother, from the beginning, seemed
rather impervious to him; interested as she was
only in the placenta and in his sex. It is therefore
impossible to know in these two cases what
comes from where, what is genetic and inherited
and what is environmental. Was Gianni already
like that from the start? Or was his closure a
reaction to a massive bombardment of, say,
hormones? Could the environment make itself
felt already in utero? Both ways his mother
transmitted something to him.
What one derives from this research is also
an idea of the complexities and differences at
play in shaping every human being. Each child
seems different and many and varied factors
intervene in its subsequent development. See for
instance Gianni's reaction to his meeting a
'stupid' au pair or to his father's presence at
Christmas.
What strikes me most so far is the kind of
continuum of behaviour one can observe in life
before and after birth and such continuity seems
to be in tune with the brilliant intuitions of
several great figures of the past. Freud (1926)
thought that, 'There is much more continuity
between intra-uterine life and earliest infancy
than the impressive caesura of the act of birth
would have us believe ... ' (p. 138). Melanie
Klein always maintained that children were born
with a character and that mental life was already
present at birth. Bion too always stressed the
importance of our unknown past.
SUMMARY
This paper describes research on the extension
of infant observation to pre-natal life with the
aid of ultrasounds.
First there is some mention of the technique of
ultrasounds and of the advances in our
knowledge of pre-natal life brought about by it.
A description of the research follows: 5-6
ultrasonographic observations lasting about one
hour each starting from the 14th-18th week of
pregnancy are carried out at monthly intervals
till the end of pregnancy. During such
observations the behaviour of the foetus is
observed and each time the behaviour of the
mother is also taken into account. After birth
mother and child are then followed at home with
infant observations as described by Bick.
So far this research seems to be pointing to
the possibility of detecting early markers of
character already in utero. Two examples are
given to illustrate this thesis.
I am greatly indebted to Prof Mangioni, Dr Vergani and
their team for their invaluable help.
TRANSLATIONS OF SUMMARY
Cet article decrit une recherche sur l'application des
ultrasons a l'observation du nourrisson au cours de la vie
prenatale.
L'auteur donne d'abord quelques informations sur la
technique des ultrasons et les progres qu'elle a permis dans
nos connaissances sur la vie prenatale, Puis suit une
description de la recherche: 5-6 observations ultrasono-
graphiques, d'une heure environ chacune, entreprises a partir
de la 14eme ou de la l Seme semaine de grossesse sont
realisees a intervalles mensuels jusqu'a la fin de la grossesse.
Au cours de ces seances, on observe Ie comportement du
a
foetus: chaque fois celui de la mere est egalement pris en
compte. Apres la naissance, mere et enfant sont suivis a la
maison et des observations de nourrisson telles que Bick
les a decrites sont realisees.
A ce stade de la recherche, il semble que I'on puisse
envisager la possibilite de detecter deja in utero les premiers
traits du caractere. On donne deux exemples pour illustrer
cette these.
Dieser Aufsatz beschreibt ein Forschungsprojekt tiber die
Ausdehnung der Baby Beobachtung auf das vorgeburtliche
Leben mit Hilfe von Ultraschall.
Es werden zuerst Erliiuterungen zur Technik des
Ultraschalls gegeben und es wird die Bereicherung unseres
Copyrighted Material. For use only by StockholmUni. Reproduction prohibited. Usage subject to PEP terms & conditions (see terms.pep-web.org).
INFANT OBSERVATION FROM BEFORE BIRTH
Wissens uber das vorgeburtliche Leben beschrieben, die mit
seiner Hilfe zustandegekornmen ist. Danach wird das
Forschungsprojekt beschrieben: mit del' vierzehnten bis
achtzehnten Schwanyerschaftswoche beginnend. werden
funf bis sechs, jeweils eine Stunde andauernde ultrasono-
graphische Beobachtungen angestellt, die in monatlichen
Intervallen und bis zum Ende der Schwangerschaft
ausgcfirhrt werden. Wah rend dieser Beobachtungen wird das
Verhalten des Fetus beobachtet, wobei jedesmal auch das
Verhalten del' Mutter berucksichtigt wird. Nach del' Geburt
werden Mutter und Kind dann zu Hause, nach der von Frau
Bick beschriebenen Methode, weiterbeobachtet.
Bis jetzt scheinen die Untersuchungsergebnisse auf die
Moglichkeit zu deuten, fruhe Anzeichen von Charak-
termerkmalen bereits im Uterus identifizieren zu konnen,
Abschliebend werden zwei Beispiele angcfiihrt. urn diese
These zu belegen.
REFERENCES
BICK, E. (1964). Notes on infant observation in
psycho-analytical training. Int. 1. Psychoanal., 45:
558-566.
BIRNHOLZ, C, STEPHENS, J. C & FARIA, M. (1978).
Fetal movement patterns: a possible means
of defining neurologic development mile-
stones in utero. ArneI'. J. Roentgenology, 130:
547-550.
DE VRIES, J.I.P. et al. (1981). Fetal motility dur-
ing early gestation, a longitudinal study. In
Proceedings of the 8th Conference on Fetal
Breathing and Other Measurements, Maastrich,
October 29-30 1981, ed. De Haan. Maastrich,
Netherlands.
- - (1982). The emergency of fetal behaviour. I
Alessandra Piontelli
Largo Richini I
20122 Milan
(MS. received July 1986)
463
Este articulo describe una investigacion llevada a cabo
consistente en la extension de las observaciones infantiles a la
vida prenatal, mediante la ayuda de ecografias.
Se habla en primer lugar de la tecnica de la ecografia, y de
los avances que esta ha producido en nuestro conocimiento
de la vida prenatal. A continuacion se describe la
investigacion en si, que consiste en 5 0 6 observaciones
ultrasonograficas a intervalos de un mes, de I hora de
duracion a partir de las semanas 14 ala 18 del embarazo y
hasta el final del mismo. En elias se observa la conducta del
feto y se toma nota asimismo de la conducta de la madre.
Despues del parto se prosiguen las observaciones de madre y
bebe en el hogar, segun el modelo ideado por Bick.
Los resultados de la investigacion hasta el momenta
presente parecen apuntar a la posibilidad de detectar rasgos
de caracter ya en el utero. Para ilustrar la hipotesis se aportan
dos ejemplos.
Qualitative aspects. Early Human Develop., 7: 301-
322.
FREUD, S. (1926). Inhibitions, symptoms and anxiety.
S.E. 20.
IANNIRUBERTO, A. & TAJANI, E. (1981). Ultrasono-
graphic study of fetal movements. Seminars in
Perinatology, 5: 175-181.
PIONTELLI, A. (1986). Backwards in Time. Perthshire:
Clunie Press.
TIMOR-TRITSCH, I. et al. (1976). Classification of
human fetal movement. ArneI'. 1. Obstet. Gynaecol.,
6: 70-77.
---(1978). Studies of antepartum behavioural
state in the human fetus at term. ArneI'. J. Obstet.
Gynaecol., 130: 693.
Copyright © Institute of Psycho-Analysis, London
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