PREMATURE-PREMATURITY

A premature or preterm baby (Voyer, Marcel, and Magny, Jean-François, 1998) is a baby born with fewer than thirty-seven weeks and six days of gestation. Babies born before the thirty-third week of gestation are considered significantly premature; pregnancies that end earlier than the thirty-first week of gestation pose the greatest problems. Today, the vital and neuro-developmental prognosis is very good for preterm babies born after thirty-three or more weeks of gestation.

Premature birth disrupts the conditions necessary for the normal development and physiology of the fetus. A new environment must take over the tasks of the maternal placenta, including respiration; the baby's genetically programmed maturation is henceforth dependent on postnatal maturation, prematurely exposed to the outer world (Soulé, Michel, 1992).

Beginning in the 1970s psychoanalysts began making their specific contribution with regard both to the premature baby as person and to parents and caregivers (Satgé, P., and Soulé, 1976). The preterm baby's specific modes of interaction (Di Vitto, Barbara, and Goldberg, Susan, 1979; Field, Tiffany, 1979; Minde, Klaus, 1980), as well as the child's capacities and competence, became better known (T. Berry Brazelton). The notion of the "interactive pattern," which describes different styles of parental interaction, also appeared.

Direct infant observation (that of Esther Bick, and Michel and Geneviève Haag), together with the work of the neo-Kleinians, was applied to hospitalized pre-term babies (by Catherine Druon, Joyceline Siksou, and Yolaine Quiniou, among others) and contributed to a closer understanding of the baby's emotional life and bodily states during these first days of life, which are decisive for the foundation of mental life, according to Bernard Golse. Shared observation aims to support, or even treat, the interactive capacities of those participating: mother, father, and caregivers, any of whom may be impeded by the situation or their own personal state. Faced with this exceptional newborn, often closer to a "fetus out in the air" than to their fantasized, imagined baby, the parents find themselves in an almost experimental situation (Kreisler, Léon, and Soulé, 1995).

Psychic trauma can be serious when reality seems to authenticate the fantasies inherent in pregnancy, such as the birth of something strange, or a crisis in parental identity, which are magnified by the preterm birth (Aubert-Godart, Anne, 1998;Frichet, Anne, 1998).

The baby's physical prematurity has as its correlate an unfinished pregnancy, mirrored by the prematurity of the mental process of becoming a parent. The maturation of the internal object is brutally interrupted and the necessary imaginary work during pregnancy of dreams and fantasies regarding the expected baby is suspended. The "unanticipatable" and unrepresentable reality of the newborn, both strange and a stranger, can imprison its parents in a traumatic present.

The parents in the making, persecuted by an amputated pregnancy, a catastrophic birth, and an anxiety-provoking infant, develop intense and ambivalent feelings of strangeness, guilt, and shame, magnified by the necessary separation of hospitalization. The psycho-pathological risks they run are exacerbated if the parents have fragile personalities. Their mental difficulty in assigning the baby a place within the symbolic universe of the family and transmitting to the child what Serge Lebovici has called the "transgenerational mandate" expresses both their wounded narcissism and their current inability to enter into a relationship with their baby. Therapy sessions are necessary to support their emerging and vacillating sense of parenthood.

In such cases, the team of caregivers relies on a multidisciplinary effort to promote psychical working over, led by the psychiatrist, the psychologist, and the psychoanalyst. Caregivers work together, beyond strict medical or nursing care, to promote a gradual "revelation" of the parents' nurturing abilities and the overall development of a newborn who is "good enough."

Anne Frichet

See also: Infant development

Bibliography

Aubert-Godart, Anne. (1998). Entre adulte et bébé, l'étrange désordre de la naissance. In Le bébé, l'intime et l'étrange. Paris:Érès.

Druon, Catherine. (1996).Á l'écoute du bébé prématuré: une vie aux portes de la vie. Paris: Aubier.

Frichet, Anne. (1998). Intimité perdue, intimité naissante: l'étrange prématuré en quête de familier. In Le bébé, l'intime, et l'étrange. Paris:Érès.

Kreisler, Léon, and Soulé, Michel. (1995). L'enfant prématuré.In Nouveau traité de psychiatrie de l'enfant et de l'adolescent. (p. 1893-1915). René Diatkine, et al. (Eds.). Paris: Presses Universitaires de France.

Soulé, Michel. (1992). Introduction à la psychiatrie foetale. Paris: E. S. F.