MEDICAL CARE: INTERNAL CHANGES DURING PREGNANCY. LIFE-SUPPORT SYSTEM

Due to hormonal changes, most women have their sexual desires markedly augmented so that the zenith coincides with the moment of ovulation or soon after. So it is not all apparent chance and luck. It is really by very cleverly devised means that it occurs so frequently this way.

As soon as conception occurs, and the chromosomal count is reconstituted back to forty-six (including the XX or XY ones giving the individual his sex characteristic), the cell commences to divide and divide again. All this time it is gradually propelled down the length of the Fallopian tube by gentle muscular movement aided by pulsations from the “cilia,” little hair like projections that protrude from the cells lining the tube. These set up sweeping waves that help carry the egg towards the cavity of the womb.

By the time the egg has reached the womb, the lining is quite ready to accept it. Very quickly the egg becomes embedded in the endometrial layers, usually at the upper part of the womb, either toward the front or back. Very occasionally it becomes embedded low down near the uterine outlet. But this can lead to problems at a later stage, and more has been told of this in relation to a condition called placenta praevia, in another chapter.

By now the egg has become a solid mass of cells called a morula. Under the influence of hormones from the corpus luteum of the ovary, small projections called villi grow from the outer surface of the egg. These help it become embedded even more intimately. Very rapidly, in fact, in a matter of days—the junction between the uterine wall and the egg develops into a powerful organ which is to become the placenta, and finally the ‘ ‘after-birth” at the time of baby’s birth.

Life-support System

This is the organ through which the developing baby will come into very close contact with the mother’s blood supply. In fact, this becomes its supply channel, for food, oxygen, vitamins and all other nutritional supplies. It also becomes the developing infant’s method of disposing of its own waste products.

At no time does the mother’s blood actually come into contact with that of the baby. The two are completely separate, but they are separated only by a very fine barrier. Through this barrier diffuse both ways, foods and waste products. It is an amazing exchange system, but a very workable and practical one.

The fertilized egg quickly develops. The placenta forms and the rest of the womb fills with fluid called liquor amnii, or amniotic fluid. The baby is known as an embryo in the early stages, and as it further develops it is called a foetus (which is sometimes also spelled fetus).

Besides being the exchange site for food and oxygen, the placenta is also a powerful factory. It produces chemicals called hormones which are vital to the safe development of the baby. An important one is called “H.C.G.,” short for human chorionic gonadotrophin. After a few weeks this production becomes high, so much so that excessive amounts circulate in the blood and are excreted by the mother in her urine.

This forms the basis of the pregnancy tests which are often used to prove or disprove the presence of pregnancy in a woman who is unsure. Using a special technique called radio immunoassay, or a simpler “immunological test” on the urine, the hormone’s presence can quickly be determined. It means the doctor is taking advantage of a naturally occurring situation when he has this test carried out.

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FAMILY MEDICAL CARE: LEGAL TERMINATIONS OF PREGNANCY

The net result is a rapidly increasing rate of legal terminations. Indeed, some doctors believe the interpretations have made it all too easy. But the proponents claim that these enlightened measures have almost entirely removed criminal abortions, and these were the areas that produced so many medical problems in years past.

So, whether it is for better or for worse, there seems little doubt that the new attitude to legal terminations will be here, and in most Western countries, for a long time to come.

Although some will use it in its widest interpretation and allow cases of a questionable nature to receive treatment in this manner, many other doctors will tend to stick to what they believe is right. They will recommend legal termination when it truly means that the total health and welfare of the lives- at stake are seriously involved.

At least, as the proponents claim, it has largely reduced (and in many countries completely eliminated) the amateur, and the backyard, illegal operator from the scene. Enormous numbers of women (claimed to be 10 to 15 per cent of all pregnancies in Western lands) ended up having illegal (criminal or “induced”) abortions carried out.

The circumstances were often anything but ideal. Hygiene and sterility were often lacking, and in some cases non-existent.

Actions were often rushed, and the operator was often quite unsuited and inadequately trained for the operation. Many cases of bungling inefficiency are on record. Many patients became infected and deaths occurred on numerous occasions. Some women had to be subsequently admitted to hospital for a “clean up” operation, and treatment of their sepsis (infection).

At least, under the new system, terminations are carried out in properly equipped hospital operating theatres, complete with all facilities to meet any eventuality. The surgeons are trained gynaecologists, quite expert with their duties.

There are certain medical indications for the need for therapeutic abortion (or legal termination). Carried out in its rightful place, this can be of major assistance to a mother in need. However, before any mother rushes into an abortion clinic to have the baby destroyed (and that is what it actually is) please think of the moral issues involved. The foetus you destroy is actually a living being. Though small, it is a perfectly formed human being. Is it right that you should take the life of this human being simply because it is inconvenient for you to give birth to it? Have you the right to say whether it shall live or die merely because its presence might curtail your social life, strain your budget, interfere with your career or embarrass you by its presence? You have no moral right to decide whether this unborn child shall live or die. If you make the wrong choice, you will never be free of the guilt pangs which people with consciences know when they choose abortion as an “easy way out.”

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MEDICAL CARE OF PREGNANT WOMEN: DAILY REQUIREMENTS

The recommended “Daily Allowance” of nutrients for the average pregnant woman (from the twentieth week on).

Kilojoules 10,500 (2,500 Calories)

Thiamine 1.0 mg

Protein 65 g

Riboflavin 1.5 mg

Calcium 1,000 mgm

Nicotinic Acid 15.0 mg

Iron 15 mg

Ascorbic Acid 50.0 mg

Vitamin A 6,000 u

Folic Acid 1.0 mg

Vitamin D 4,000 u

This may all sound a bit theoretical. But, when this is translated into understandable words, it simply means that the following foods should be included in the diet each day:

One pint (.6 litres) of fresh milk. (This may be taken raw, or made up in drinks, puddings, custards, or in the form of cheese.)

60 g (2 oz) of fish or meat (or protein substitute) and one egg daily.

One orange, one apple or a slice of pawpaw (papaya).

Green, leafy vegetables at least three times a week.

Apart from this simple routine, she may eat whatever she likes! However, a careful watch must be kept on the weight, for this is important during pregnancy. Sudden weight increases can lead to a serious complication in pregnancy called pre-eclampsia.

The majority of women will also benefit from the regular intake of an iron tablet daily. The actual amount will vary according to the results of the blood tests arranged by the doctor at your early visit to him.

Some women who live under poor social and economic circumstances, and women in the less affluent, developing countries may require additional vitamin and mineral needs if their diet is deficient. Such people would benefit from an iron tablet three times a day, and a vitamin tablet containing ascorbic acid 50 mg, folic acid 1 mg, thiamine 2 mg, riboflavin 2 mg, and nicotinic acid 15 mg.

Vitamin Names. Many women become confused at the seeming profusion of vitamin names. The most commonly talked about group of vitamins are those composing the “Vitamin  Complex.” This consists of a series of components, and there are several synonyms.

Vitamin B1 is also known as Aneurin or Thiamin.

Vitamin B2 is also known as Riboflavin.

Vitamin B6 is also known as Pyridoxin.

Nicotinamide and Pantothenic acid belong to the complex also.

Vitamin B12 is also known as Cyanocobalamin.

The other commonly used multiple name vitamin is Vitamin C, which is also known as Ascorbic acid.

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FAMILY MEDICAL CARE: X-RAYS FOR PREGNANT WOMEN

Thirty years ago, it was almost routine for pregnant women to have a radiological procedure called “pelvimetry” carried out.

This was aimed at measuring the bony outlet of the pelvis, and assessing if there was adequate room for the baby to pass freely through during labour and the delivery.

However, in recent years, the full force of the power of X-rays on rapidly dividing foetal cells has become more apparent.

Radiation damage and the possible development of genetic mutants is universally recognized. Therefore, the wild enthusiasm for radiography has come to an abrupt full-stop during pregnancy.

Now, every effort is made to protect women hospitals, X-rays of the pelvis or abdominal areas will be carried out only when it is known for certain that pregnancy does not exist.

Considerable efforts are made to this end. In some instances, X-rays during pregnancy may be essential. Under these circumstances, special precautions are available for the mother and infant who are at special risk. The practical application of this lies in a pregnant woman inadvertently subjecting herself to X-ray doses without thought.

In many areas, mass radiography is still carried out. It is wise to consider this if you are invited to attend for these purposes, or to embark on any mass screening system. As one obstetrics expert recently wrote: ”No female who might be pregnant should ever undergo any pelvic radiological investigation in the second half of the menstrual cycle.”

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VIRUS INFECTIONS DURING PREGNANCY: TREATMENT OF MATERNAL RUBELLA

Offering a woman a legal termination of the pregnancy may solve the short-term problem. But on the wider horizon, much can now be done for women in general.

The ready availability of rubella vaccination has changed the entire picture. The most satisfactory form of protection is for a girl to have an attack of rubella during childhood. This gives excellent protection from subsequent attacks. In many countries school-children in the age group when pregnancy is least likely are now offered rubella vaccination. This confers excellent immunity. It is by no means 100 per cent effective (as was originally believed), but it is certainly far better than no protection at all.

Older women who have not been vaccinated may receive vaccination provided pregnancy does not occur within the following three (or preferably four) months. With the universal availability of contraceptive methods these days, this is usually not difficult. If by some misfortune conception does occur within the three-month limit, then the foetus runs a certain risk, but it is much less. In 1981, a check on 100 pregnant women in America who were vaccinated during the first three months, showed no congenital defects at all. Officially the risk for defects is between 0 and 5 per cent. This contrasts sharply with between 20 and 25 per cent in completely non-immunized women who developed rubella in the first three-to-four months of pregnancy.

Because many women are completely unaware whether they have contracted rubella or not during their younger life, a specific test to check on this is available. It is known as the H.A.I, test, short for Haem-agglutination Inhibition test, and is readily and accurately carried out by pathological laboratories. It measures the body’s level of rubella “antibodies,” specific elements that confer protection. So, if there is a high level of antibodies, then the woman is fairly safe from subsequent attack.

If the infection occurs during pregnancy, and there is doubt about her antibody state, a check with the H.A.I, test may be made at once. It is then repeated two to three weeks later. If there is a sudden subsequent rise in “titre,” then it is presumptive evidence that rubella infection has occurred, and the risks can be outlined to the patient, and the correct advice offered to her.

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SEXUAL ATTRACTION: EARLY EXPERIENCES OF INTERCOURSE

A critical review of the evidence suggests that the age at which intercourse starts is mainly governed by the genetic blueprint as modified by earlier sexual and emotional experiences. Personality development and social skills have to be sufficiently well developed to attract a partner but their availability for sex and emotional exaggeration are also important ingredients.

On balance girls think they are looking for a romantic relationship and boys for a physical one. Girls generally are hoping for their search to end in security, while boys are looking for adventure, but there are probably more girls around today in an adventurous frame of mind and boys in a romantic one.

Emotional and sexual attraction are complex issues of which we know only a few dimensions. Variations in taste between individuals ensure that almost any man or woman will be attractive to someone of the opposite sex. Hairy women, for example, often believe themselves to be unattractive but some men prefer them. Physical differences and even disabilities can be attractive to others. Physical attractiveness is the most important factor to young adolescents and to adults looking for brief affairs. Distinguishing emotional attraction from the physical is mainly an adult skill.

For women particularly, how attractive they feel greatly influences how attractive they are. A good morale is vital to one’s sense of attractiveness.

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SEXUAL ATTRACTION: FACES AND HEIGHT

There is evidence to suggest that there is a widely held notion of the ‘ideal’ face. In one study people were shown photos of twelve young women between the ages of twenty and twenty-five and there was marked agreement as to which faces were the most attractive. The only people who disagreed to any extent were the over fifty-five-year-olds and some members of the unskilled occupations.

As so many people agreed about what is attractive they must clearly be making their judgement using certain shared standards. People shown photographs of physically attractive people readily assign them more socially desirable attributes than they do photos of unattractive people. On balance, we also assume that attractive people will be more likely to hold top jobs, be better parents, be more happily married and have better lives generally. It also seems that we are more likely to trust physically attractive people on a first meeting than the physically unattractive. This confers a tremendous advantage on the attractive because by definition almost all contacts are one-offs and will never get any further if there is no immediate attraction. There is a greater chance that this immediate attraction will happen with attractive people.

Height

As a man’s height increases so does our expectation of his socially desirable personal qualities. People tend to guess the height of authority figures and attractive people as taller than they actually are and one researcher has noted that every American president elected since at least 1900 has been the taller of the two major candidates. Women almost everywhere invariably prefer men who are taller than themselves.

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MID-ADOLESCENCE

Middle adolescence, or adolescence proper, starts at around the age of fourteen or fifteen in girls and fifteen or sixteen in most boys. By the end of early adolescence boys are still mainly homosexual in a social sense but an interest in girls has started to develop. Nevertheless the boy is still looking towards boys rather than girls for approval and friendship. Any social contacts with girls are usually undertaken along with other boys. Although for most girls the main friendship is with another girl, a girl’s heterosexual drive and interests have been much greater than those of boys throughout early adolescence. A girl with a boyfriend is likely to think of him as her best friend.

A recent survey of nearly 800 fifteen-year-olds revealed that girls, compared with boys, were more concerned about their personal safety, their ‘looks’, criticism from others, arguments with their parents, confusion about life, speaking-up in class, the health of their mothers, obtaining a job eventually and their ability to do it well. The concerns of girls are thus more mature and adult than those of boys at the same age. Worries about their mothers’ health may reflect the tendency of mothers generally to use emotional blackmail to control older girls by making remarks about the consequences of the girls’ behaviour on their health. The phase of conflict between mother and daughter can become ferocious and may result in the girl running away or becoming pregnant to punish the mother. If a girl feels she receives only criticism instead of help and understanding she may think these or other dramatic acts are necessary.

A lot of this kind of trouble could be avoided if parents recognised that most girls are in a conflict over their desire to please their parents but also to grow up and fulfil their own needs. Adolescents, both boys and girls, criticise themselves enough and require little in the way of external help in the matter! Approval and success at home increase their self-confidence and protect them from excessive peer-group pressures and also from flagrant rebellion.

Survey evidence shows that the majority of mid-adolescents get on well with their parents and respect and admire them. A survey of 1000 teenage boys revealed that most felt understood by their parents, regarded their discipline as reasonable and were proud of them. Nevertheless, mid-adolescence is the time when the instinctual sex drive is finally withdrawn from the direction of the opposite-sex parent and is invested in the adolescent him- or herself. Masturbation rates tend to rise, as does a preoccupation with the self and the body. The capacity for abstract thinking which starts in early adolescence increases and results in mid-adolescence being a potentially creative period. Girls may begin to keep diaries recording their moods and activities. Emotional and romantic feelings can be inspired by things such as literature and landscapes. Poetry writing may start. Although mid-adolescents can be savage, more in the way of mindless violence than for any purpose, the stage is usually one in which inner feelings of tenderness and beauty develop.

Sexual fantasies keep in step and, although they may include unusual or even ‘deviant’ elements, active involvement with the opposite sex begins to emerge in fantasies. Although girls may have earlier explored their vaginas and many may have used tampons, the vagina becomes more significantly incorporated into the body-image at this age. Earlier, unsophisticated fantasies give way more to fantasies of ‘making love’. Psychosexual history-taking from a spectrum of girls and women, not just those with sexual problems, shows that by the age of sixteen something like three-quarters of girls have included vaginal activity both in their fantasies and their masturbatory practices. The physically relatively insensitive vagina now becomes psychologically valuable and can give her physical pleasure.

Thoughts of using her vagina to show her emotional feelings to a boy, and the pleasure he will obtain from it, become exciting.

Mid-adolescents may be involved in heterosexual relationships and intercourse is common. A 1987 study of 6000 readers of a UK woman’s magazine found that the average under-zo had lost her virginity at 15.8 years. This is also a time of sexual rehearsal in fantasy and self-generated romanticism which may be placed on a member of the opposite sex though almost always in a play-acting way. This is not to deny that, for example, a sixteen-year-old girl can love a boy, but it must be said that she can only love him to the extent to which a sixteen-year-old is capable. Although mid-adolescents may wax lyrical about their boyfriend or girlfriend, when seen a year or two later, they not infrequently have some difficulty in recalling their names. Early and pre-intercourse heterosexual experimentation may arise in this stage and fondling of the breasts and vulva may occur, but most girls are too shy and most boys too ignorant for this to progress to mutual masturbation. Most girls do not handle their boyfriends’ penises during this stage. However, many mid-adolescent and some early-adolescent girls behave provocatively, not so much with the intention of having intercourse but more to reassure themselves that they can attract male attention. Such behaviour can be misunderstood by boys and men and rape, or something close to it, may be the result.

Mid-adolescence is the true turning point from childhood to adulthood. As well as sexual, emotional, social and personality development taking place, career choices are usually being explored. It is a time of expansion but the mid-adolescent still relies heavily on his or her parents. Moods can change rapidly from feelings of despair to exaltation and day-dreams are common. Everything and yet nothing seems possible.

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BABY AND CHILDHOOD SEXUALITY: THE PRE-ADOLESCENT STAGE

Hormonal changes occur as puberty approaches. Girls who stopped masturbating at the end of the phallic stage often start again around the age of nine or ten. It is still an ‘innocent’ activity which the girl may feel little guilt about unless she was criticized or punished for earlier masturbation or sex games. This increase in eroticism may be reflected in an increasing interest in portrayals of nude adult females and the father who was previously welcome in the bathroom is now banned.

Dreams or fantasies of appearing partially or wholly nude occur and are exciting. Sex games are undertaken now only with other girls and under the guise of dressing-up games or sexual enactment games such as kiss-me-like-a-boy-would and mutual genital inspection and bottom smacking may occur. The phase is a sort of ‘homosexual’ one and is perfectly normal. Girls rarely teach each other to masturbate-unlike boys. The reason may be that sexual skills are more innate in girls whereas in boys, as in higher primate males generally, there is a larger learned component to sex. Girls can seem to be very mature just before puberty and often take a special interest in relationships between the sexes, both human and animal.

Boys tend to gang together even more strongly in pre-adolescence and although there may be mutual showing of genitals it is not really a homosexual stage. They tend at this stage to denigrate women, presumably because of residual fears of them from earlier childhood arising from encounters with them in the form of mothers and teachers, and they also tend to regress towards the anal stage. Talk about excretion and breaking wind, making noises, eating crudely and failing to wash adequately are signs of this regression.

At this point, the end of latency, the first half of childhood is complete. The child has largely been reared within the small world of his or her own family with its particular combination of advantages and disadvantages. Any harm done in the process of psychosexual and other development will, from now on, become increasingly evident. It is this long incubation period between cause and effect which makes it so difficult to be sure about the significance of earlier events. The distortion of memory, the inaccessibility of the unconscious and the repression of painful thoughts and family myths make it hard to disentangle the facts. The most important lessons in life, the very early ones, do not even register in the conscious memory. And yet, in spite of the problems, it is possible to use the information given briefly in this chapter to understand what lies behind the difficulties experienced by adolescents and adults in their relationships with others and themselves. From what they say and avoid saying, from the way they say it and their associated emotional changes, from their dreams and fantasies, from their preferences and practices, and in other ways, it becomes possible to know what happened to them and how they felt, even unconsciously, during childhood. Sometimes repressed material is retrieved from the unconscious and the person then relives it as vividly as if it had occurred only an instant before and all the emotions originally associated with it return.

Of course everyone is different, but three patterns constantly recur in clinical practice though they appear in many guises. The first is a poor relationship with the self, involving excessive self-criticism, excessive self-consciousness, self-detestation or depression and excessive

self-blame. The two main causes are disturbed parental relationships, the child perhaps having been at least partly unwanted or believing himself or herself to be, and poor child spacing. The second is the suppression of sexuality, resulting in the child being frozen at some particular stage, perhaps making him or her regress to an earlier stage or deviating him or her from ‘normal’ development. The third is a persistent attachment to the opposite sex parent which can arise, amongst other reasons, if that parent was over-close or over-rejecting. The consequences can be profound not only for the individual’s future sexuality but for his or her emotions, personality and inter-personal relationships.

Although this brief account of baby and childhood sexuality can be verified by the average observant person, it is still not universally accepted. Some people find it hard to believe that events in childhood can exert such a profound effect on such matters as the ability to enjoy intercourse later in life. If it is accepted that infant and childhood sexuality and the way it is handled are the foundation for what comes in adulthood, then its enormous importance can be readily appreciated. To argue that childhood experiences have no bearing on events in later life is contrary to all the available evidence and also to common sense. After all, we happily accept such reasoning on non-sexual matters.

A more subtle and difficult criticism arises in the question of why children who are treated in virtually the same way with regard to sexual and emotional matters display totally different sexualities and sexual problems in adulthood. One answer lies in the fact that apart from one-egg twins no two individuals are genetically the same. Another answer is that no two people can really be subject to exactly the same influences and therefore any two people will respond differently to similar experiences. How secure children feel in their place in the family also affects their vulnerability to experiences. Also, the child’s own perceptions of what is happening may be different from those of a brother or sister who is going through the same experience.

For these, and no doubt other reasons, the long-term consequences of a similar upbringing can vary enormously. Parents too are not static personalities — they change as the years pass and react differently to, and therefore have a different influence on, each of their children.

All of this makes the study of childhood sexuality a minefield but an understanding of the processes outlined in this chapter can put problems into some sort of perspective. We are a product of all our yesterdays as well as of our genetic blueprint.

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THE STAGE OF THE MOUTH (THE ORAL STAGE)

Once it is realised that sexuality and genitality are not the same thing it becomes possible to discuss infant sexuality without impugning a baby’s ‘innocence’. The notion that a baby’s lips and mouth are sources of intense pleasure is acceptable to almost everyone, especially anyone who has watched a baby feed at the breast. Later, following the blueprint, other areas become the focal point of peak pleasure, the mouth remaining pleasurable but not primarily so as in a baby.

The phase of development when the mouth is the primary source of pleasure is called the oral stage. We know that the oral stage starts before birth because foetuses have been seen both on

X-rays and scans to suck their thumb in utero. The bliss and contentment a baby displays on sucking after birth, if all goes well, is very plain to see. Mothers usually hug their babies to their bodies, talk soothingly and rock them. In doing so they are giving the child much more than milk. They are building up a sense of trust and confidence and are laying the foundations for the child to see itself as a person who is loved and valued. Provided the baby is not allowed to become too frustrated when he or she needs food or maternal attention, he or she will slowly begin to experience feelings which eventually lead to a sense of optimism, self-assurance and perhaps even self-esteem.

If the mother repeatedly leaves the baby to scream untended she will lay the foundations for self-doubt, depression and distrust of the world. It is quite possible to see that repeated and severe frustrations of the baby’s oral drives and needs, even at this early stage, could result in their excessive persistence in later life. They may not remain primary but they may remain so strong that they influence both sexuality and other behaviour. It is certainly widely held that babies that do not enjoy and fulfil this oral stage as they should are more likely to want ‘oral’ gratification in adulthood. This can manifest itself in cigarette smoking, in certain cases of alcoholism, in persistent eating (especially under stress), or even in an unusually high level of interest in oral sex.

Although sucking at the breast or bottle relieves a baby’s hunger it is also pleasurable in its own right and children, when they can control the movement of their muscles effectively, suck their thumbs if no other source of oral pleasure is available. Later still the child learns to suck, or at least to put in his or her mouth, almost anything appealing in the environment. These are

self-pleasuring or auto-erotic activities and may, without stretching the imagination too far, be seen as a forerunner of masturbation. The opposition that thumb sucking, especially in older children, often encounters from parents, presumably recognises this fact, no matter how unconsciously. Of course at the conscious level the parents’ fear is that others will think the child is babyish, unloved or that his teeth will be displaced.

This can be used to illustrate a point of general importance. Although we all want pleasurable experiences, the ways in which we obtain them most naturally may not necessarily be socially acceptable. Because of this, restraint is taught in childhood. For example, an adult man sucking his thumb would be considered very odd but sucking a pipe is quite acceptable.

To generalise further, many of our pleasure drives are opposed, at least in part, by cultural conditioning and are, as a result, displaced on to other activities which gratify a particular need in a way that is, perhaps, less satisfactory but more socially acceptable, thereby possibly leading to a mild degree of frustration. These displacements are taken to be the mark of civilisation and the process is thought to account for many great achievements in the area of creative thinking, writing, painting, music, sculpture, and so on.

In a humbler form the displacements probably enrich our lives and comfort in many ways. For example, a woman’s displacement of pleasure drives to her home, social life and children usually improves life for all concerned. Men, or some men, may, perhaps for a genetic reason, be capable of more distant displacements and this may account for male supremacy in areas of achievement. This is not to deny that women are capable of more distant displacements or men of displacements closer to the family and home; it is simply to say that the main focal points for such displacements may be slightly different for the two sexes, so enabling each to contribute slightly differently to civilisation. Men, on balance, tend to push society forwards and women to keep it there.

To return to the oral stage, parents, of course, make use of the oral drive to pacify their baby in the early stages of life. Giving him or her something to suck will lead to pacification even if no milk or food is involved.

Two further points should be made. Presumably the infant is, at first, incapable of realising that it is the mother who relieves the tension of hunger or who provides the comfort of cuddling and rocking. At first the baby must think that it is the breast that does these things. Eventually, he or she realises that the breast is part of his mother and, if all is well, the baby starts to develop the capacity to love. A newborn baby expresses love through the mouth, and attachments between the mother and child develop which build up a capacity to form stable, affectionate relationships later in life. If this stage is not happily achieved the child’s later relationships may be less than full. Sexual and emotional development are first linked in this way. Through constant contact with the mother’s body and her various attentions to his or her needs, a baby becomes aware of his or her own body and its pleasures. Self-exploration of the body follows and much later the exploration of other people’s bodies.

When an infant boy is at the breast he may have an erection. He may also have one during urination, nappy changing, bowel emptying, or as a result of any excitement. Similarly, girls may roll their thighs and, according to some mothers, even lubricate vaginally. Children learn to touch their genitals fairly early and babies have been observed to stimulate themselves to orgasm. At this stage, however, the genitals are not the baby’s primary source of pleasure. The mouth ensures survival and is still the main source of delight.

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