The Psychosomatic Concept of “Intranatal Inward Orientation” (IIO) as a Background Mode of Experience in the Birthing Process: A Scale Development Study with 73 First-Time Mothers

Objective: In order to describe maternal intranatal processes from a common psychosomatic perspective, the clinical notion of “intranatal regression” or “intranatal psychophysical withdrawal” was presented. However, this idea of an underlying mode of experience pervading the birthing process has never been explored systematically. We further elaborated on this notion by introducing the concept of Intranatal Inward Orientation (IIO), supporting a psychosomatic approach in modern obstetrics. Methods: 73 first-time mothers were interviewed 3 - 4 days postpartum. IIO was evaluated on four axes of perceptions: a changing sense 1) of time, 2) of space, 3) of attachment, and 4) a change in the predominant communication style with significant others (partners, midwives). In addition, other subjective variables (questionnaires) and obstetric variables were assessed. Results: A one-factor solution (Eigen-value of >1.0) provides firm statistical support for IIO as a consistently integrated scale (C’alpha 0.74). Interrater reliability is very good (Intraclass correlation 0.83). IIO is independent of other subjective qualities, like anxiety, coping, and control. IIO is correlated with fewer epidural blocks. Likewise high IIO is more frequently associated with a low birth complication profile (spontaneous delivery, not longer than 12 hours, no oxytocin for augmentation of labour, and no epidural block). Conclusion: IIO is a promising psychosomatic concept. It supports the idea of a psychological, relationship- and interaction-oriented approach to promote more natural childbirth. It may also lead to a better understanding of the emerging of a traumatic birth experience. Further elaboration of the concept is recommended.