Art Therapy and Childbearing Issues

Birth, Death, and Rebirth

Nora Swan-Foster, Nora Swan-Foster

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000176742
• Edition: 1
• Topic: Medicine
• Subtopic: Gynecology, Obstetrics & Midwifery

This textintroduces readers to the diverse and unique ways art therapy is used with women who are undergoing various stages of the childbearing process, including conception, pregnancy, miscarriage, childbirth, and postpartum.

Art Therapy and Childbearing Issues discusses a range of topics including the role of transference/countertransference, attachment and maternal tasks, and neuropsychology. The book also addresses several motifs that are outside cultural norms of pregnancy and childbearing, such as racialsociopolitical issues, grief and loss, palliative care, midwifery, menstruation, sex-trafficking, disadvantaged populations, and incarceration. Each chapter offers research, modalities, case studies and suggestions on how to work in this field in a new way, accompanied by visual representations of different therapy methods and practices.

The approachable style will appeal to a range of readers who will come away with a new awareness of art therapy and a greater knowledge of how to work with women as they enter and exit this universal, psychobiological experience.

1 Introduction

Background Considerations for Childbearing Issues and Art Therapy

Nora Swan-Foster

The pediatrician and psychoanalyst D.W. Winnicott (1960) expressed that the infant cannot become an infant without a mother. This notion poignantly highlights the pivotal role of a woman’s maternal identity and how art therapists can have an incredibly significant impact for women during this major life stage. The images that women create in art therapy, and their connection with other women, allows them to see parts of themselves not yet seen by the world. Caring for themselves during pregnancy and postpartum by making their internal world visible to themselves and others is an integral part of their maternal preparation and growth. Drawing from the creative and spiritual renewal found through art therapy, they can better see and provide care for their infants. This process is slightly different for mothers who endure losses—grief is more consciously interwoven into what it means to become a mother, to be restricted to only holding their babies, sometimes dead, sometimes in the care of others, in their minds and hearts. Childbearing issues form the center of a woman becoming a mother and yet her journey never unfolds perfectly. Instead, it is a collaborative endurance, and a creative and spiritual growth process called matrescence, an anthropological term that describes a holistic and compassionate acknowledgement of maternal growth and identity (Athan, 2017; Raphael, 1975). Art Therapy and Childbearing Issues examines a few of these important variations and ingredients.

When I lived in a Boston brownstone in the mid-1980s, our apartment was above a single mother who worked as a nurse midwife and saw patients at home in addition to working hospital shifts. I regularly met pregnant women in the foyer. And over tea, she told me her midwifery stories—the accounts of long sleepless nights, what helped, what did not, and the continuity of medical and psychosocial care between her, the midwife, and her medical team. While the fetus was always considered, I was impressed by the continuity of care for the physical and emotional adjustment of the mother and infant that begins early in pregnancy and extends six to eight weeks into postpartum. Women who lost their babies were also given this continuity of care.

During this time, I received an informal training in medical terms, procedures, celebrations, disappointments, and grief associated with childbearing issues. I saw how an experienced midwife handled uncertainty with time, responded to unexpected events with confidence, and handled her life with both grace and authority. I learned what she considered to be normal or an emergency, and how certain events unfolded from a mismanaged pregnancy or birth. She regularly negotiated with doctors and nurses in the hallways of the hospital and supported her patients to express their feelings and make educated choices. Her home was a community where oral stories could be told with dignity, absent of shame or rebuke. Modeled by the midwifery community, I saw that when antenatal care is collaborative, it benefits both maternal and infant mental health.

As I trained and worked in maternal/infant/child mental health, I began using art therapy with pregnant women and learning about the benefits. Unlike today, art therapy was only used with those with handicaps and mental illness, but I was curious about the supposed “normal” yet hidden nature of pregnancy and childbearing issues. No matter what the outcome of the conception and gestation, I observed how the midwifery web supports and nourishes the pregnant woman’s journey and I saw how some doctors were also able to support their patients with compassionate listening ears.

My own pregnancies were life-changing events. Certainly, I encountered moments of joy, peace, and satisfaction, but there was loss, and incorporating a new identity into my life led me deeper into prenatal emotions and thoughts that arose from the collision with change and uncertainty. We packed and moved, and searched for affordable apartments and new birth communities that matched what I had left behind. I found new friends, new mothers, but spent many hours alone, pregnant, with an infant, and later with an infant and a curious toddler. I worked in adolescent treatment and child residential because of financial stress and a desire to stay connected to my professional identity. What saved me in the darkest hours was my routine with art, writing, and dreams that led me towards the illumination of symbolic connections and personal meaning; the images held and formed my uncontained uncertainty, worries, and fears. I quickly learned that the answers to my questions were not as much physical as emotional. There were turning points: I risked speaking my truth to a woman with medical authority, I switched birth providers in the eleventh hour and discovered support in an unexpected place with two compassionate male doctors. I rejected certain protocols, and my second birth was more difficult than my first birth, which contradicts traditional wisdom that it gets easier. Pregnancy, childbirth, and postpartum do not necessarily get easier. They are labors of love, sacrifice, and devotion that are concerned with curiosity and process. Uncertainty and imperfection become the moments for reflection and maturation.

What truly impacts a woman is her relationship with her partner and/or her antenatal support team. This is the web of knowledgeable support woven around the pregnant woman with supple but solid threads made of love, confidence, and encouragement. It should be this way for every single woman no matter who she is, the color of her skin, or where she lives. So essential were the family, friends, nurses, and midwives who stood beside me for long hours like they do with so many women, it is appropriate to celebrate that the World Health Organization declared 2020 to be the year to acknowledge nurses and midwifes. Perhaps the US will continue to learn from other countries on how a compassionate and caring antenatal model, with the inclusion of the creative arts therapies, can be seamlessly and economically integrated into our childbearing system that serves all people who are creating families. This is an ideal. A dream. But we should aim for no less when it comes to women, infants, and their families.

In the meantime, the collection of chapters in Art Therapy and Childbearing Issues illustrate how women are the canaries in the coal mine—if they are in trouble, then we are all in trouble. In 1978 the United States Senate passed the Pregnancy Discrimination Act (PDA) in the attempt to eliminate pregnancy-based discrimination. Although I was well aware that inequalities prevailed and women’s reproductive rights are endlessly debated in the United States, childbearing issues remain mostly a hidden topic not only within art therapy, but within the American culture. I was not naïve to the fact that the mother is either idealized and glorified or taken for granted, stereotyped, blamed, and rejected. I was aware of systemic discrimination, and yet, when I began compiling this book, I had not yet fallen so deeply into the weeds of the disturbing facts on social justice and toxic stress issues (Lakhani, 2019), or the dramatic statistics on surgeries and medical interventions (or lack thereof), maternal mortality rates (Lakhani, 2019), and the criminalization of pregnancy, childbirth, and postpartum in the US, which is determined by predominately white male legislators.

This anthology gathers clinically experienced art therapists and other professionals who care about and/or work with women and childbearing issues and cross various divides to do their work. With the support of literature, statistics, clinical examples, personal narratives, and visual art, these authors bring the woman’s perspective and maternal voices out from the shadows and they contribute their services to our communities. Through their unique lenses and experiences, the contributing art therapists provide insight into appropriate and ethical application and theory as well as future potential areas of research, clinical attention, and professional collaboration.

Certainly, there are other art therapists who are doing this work across America, gathering the stories and making visible the joys and hardships associated with childbearing issues and those areas that currently haunt a woman’s mental health and physical freedom in the United States. This book is but a heartfelt opening, a beginning—the first of its kind in this country—to focus solely on art therapy and childbearing issues. The timing is powerfully synchronistic for many reasons. Not only has the #MeToo movement ushered in a new wave of collective awareness that rises above shame and fear, but there are increasing news reports and books in this country that reveal the complicated discrimination and severity of neglect of women, and in particular, childbearing women in this country. Finally, just as this book was submitted to the publishers, the United States was impacted by the COVID-19 global pandemic with “stay at home” orders that required social distancing, masks, and a sudden interruption of celebrating the many maternal threshold crossings of the childbearing stage. The invisible but virulent virus has brought the honest truth of medical, racial, and social inequities to light and revealed in greater detail aspects of the unsupported, underfunded, confusing, and divided medical system that begs for restructuring. Additionally, childbearing women have suddenly experienced heightened anxiety, fear, and grief resulting from an abrupt lack of clear medical knowledge, and increased isolation and restrictions during prenatal, childbirth, and postpartum periods. Also, it will be remembered that mothers, or family members, have been unable to actively support their daughters as new mothers and are restricted from holding their grandbabies because of social distancing. As one mother said to me, “my baby will be grown before anyone gets to know him.” Becoming a mother requires that both mother and baby are witnessed, but the quarantine has torn asunder some of these precious shared moments of intimacy and trust that cannot be replaced through internet contact. Further, with maternal and infant deaths, families have been prohibited from comfort from touch and shared grieving rituals. While we were unable to include these stories, I recognize that this pandemic will leave behind complicated reports of joy and creativity alongside emotional and physical wreckage. Undoubtedly, future research will show that the stories of maternal/infant relational trauma and grief associated with fear, anxiety, distance and separation, lack of touch, masked maternal and paternal faces, severe interruptions and losses will all cause un-worded wounds that will one day tell an important story through art therapy.

Indeed, this book illustrates how art therapy contributes to the prevailing conversation of women and childbearing issues in a significant and creative way. As a treatment it is neither alternative nor radical; nor is art therapy a marginalized profession lacking evidence of humanizing results that build communities (AATA, 1999). Art therapy is rooted in thousands of years of humanity that has used art to honor humanity’s transitions, now joined with psychological and social theories. Those trained in the field have a solid base of theoretical knowledge, clinical experience, artistic training, knowledge of materials and professional collaboration within communities. Furthermore, art therapy is integrated and highly visible in some parts of the medical and psychosocial communities in this country, led by professionals who have devoted their life to a field that is over 70 years old. The American Art Therapy Association (AATA) recently celebrated 50 years as a professional association and that is because it has the unique and commanding ability to reveal the mythic lives that people, and in this case women, are living. Encouraging the use of the imagination, the creative process and drawing on the psychological and emotional aspects of process and product, as well as interventions and spontaneous imagery, art therapy brings fresh awareness and consciousness to the human journey. The creative process facilitates a connection between her body and her emotions and this has a subtle but clear impact on a woman’s self-esteem, her ability to articulate her thoughts and moods, and her capacity to learn that vulnerability is a strength that leads to relationships with others as she works to expand her future identity to include the identity of forever being a mother no matter the context or the outcome.

Despite the dramatic physical changes that show in the external world, childbearing women still live in the shadows. Art Therapy and Childbearing Issues encourages the subversive act of making art. In this small act, a woman has an effect, an influence, not just in her personal world, but on others in her community when she so bravely makes choices to express her inner emotions and thoughts, and address issues that matter to her and to others. But where she lives in the US matters, so let us consider just a few of the powerful divisions and their impact on motherhood.

The United States Are Divided States for Motherhood

With its 50 states and handful of territories, the United States is one unified country that defines itself as a democracy with a constitution that protects individual rights. It’s a country originally guided by the inspiring image of the towering beauty, the Statue of Liberty, that calls out: “Give me your tired, your poor, Your huddled masses yearning to breathe free” (Lazarus, 1883/2019). While a democracy depends upon individuals fighting for their rights, in America not everyone is equally cared for nor granted the dignity they deserve as human beings. The poetic invitation casts a shadow: this country is complicated, widely divided, and intensely diverse. In her discussion of motherhood, Rothman (2000) considered three main threads that define America’s current climate: patriarchy, technology, capitalism. Twenty years later, fundamentalism makes a fourth thread. The intricate power structure is often fed by complex, hideous, sociopolitical, racial, religious and geographical perspectives that are deeply and systemically ingrained and enforced by the ruling hegemony. In the US, Forbes Magazine reported 600 billionaires (Kroll & Dolan, 2019)—the highest number worldwide—who directly or indirectly benefit from these four main threads, while the middle class and the poor struggle in exhaustion to make ends meet. The income discrepancy is unquestionably the worst it has ever been. Women make up over 50% of the population and a high number are living as single mother heads of households. Any woman who is perceived as stepping outside of society’s conception of the ideal caregiver and mother is specifically marginalized, scrutinized, stigmatized, and more recently criminalized in America.

Moreover, despite the declared unity, the country has complicated environmental and cultural regions, individual state legislation, and deep roots in greed and racial discrimination of indigenous populations and immigrants; prosperity was built from a slave history and traumatic wounds that continue from before the Civil War. Psychosocial services and public health are so overwhelmed and underfunded that they may disregard the intersectionality of ethnic diversity, socioeconomic status, and the gender and age disparities that are unique in one state or region of the country but not in another. Additionally, if the federal government maintains one view, this may not always concur with local legislation on such critical issues as health insurance and medical benefits. For instance, the trend is to decrease Medicaid benefits, but one state may offer increased Medicaid benefits while the neighboring state will refuse these federal benefits because of political allegiances. These decisions affect women and children in a multitude of complex and overlapping ways.

Women’s Healthcare in America

The lack of low-cost and comprehensive healthcare and a woman’s role as a major provider for her family, despite earning less than men, remains one of the greatest stressors and areas of vulnerability (Gunja et al., 2018). Most women in the United States do not seek medical support for fear of cost until they are forced to go to the emergency room. While the Affordable Care Act has provided women with a safeguard, medications and medical services are not always fully covered and the uncertainty of hidden costs for necessary or emergency procedures can leave women at tremendous financial risk. On average women aim to have two children, which means they spend three or more years attempting to conceive, pregnant or in postpartum. Three decades of their life women try to avoid pregnancy (Guttmacher, 2019).

According to the radio broadcast “Calling the Shots” (Zwillich, 2020) there is a predicted shortage of nurses...

Table of contents

• Cover
• Endorsements
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgments
• List of Contributors
• Foreword: Matrescence
• 1. Introduction: Background Considerations for Childbearing Issues and Art Therapy
• PART I: Art Therapy: Pregnancy
• PART II: Art Therapy: Postpartum
• PART III: Art Therapy: Grief and Loss
• PART IV: Art Therapy: Special Topics of Childbearing Women
• Appendix 1: Art Therapy and Antenatal Period
• Appendix 2: Art Therapy with High-Risk Pregnancy and Antenatal Depression and Anxiety
• Appendix 3: Postpartum Depression Checklist
• Appendix 4: Resources and Training Opportunities
• Index