Frank Lake's Maternal-Fetal Distress Syndrome:
- An Analysis -

By Stephen M. Maret, Ph.D.
Professor of Psychology
Caldwell University


B. Morphological and Psychological Evidence for Lake's M-FDS

    Fetal Development
      1. Embryonal Development
      2. Fetal Development
        k. Learning

Having presented evidence that a variety of stimuli can be sensed by the fetus and can in turn be responded to, we have the rudiments of what might be termed learning. Since learning requires a rehearsal of what has been learned, we must also assume the rudiments of memory. Thus we could define learning as "a change in behavior that accrues over time as a result of experience."282 Chamberlain continues and states that "learning and memory are linked, behavior on later occasions being influenced by what happened in the past."283

Much research has focused upon the learning capabilities of neonates284 described by one researcher as having exceptional abilities for "differential responding. discrimination learning, and conditioning, often achieved in a matter of minutes"285 after birth. These capabilities. by extension, can be inferred in some measure to prenates.286 at least late- term fetuses.287 But, as Lipsitt warns, learning and other abilities do not necessarily follow

282Chamberlain, The Cognitive Newborn, 23.


284Extensive reviews of these studies have been written and Include the following: Y. Brackbill and M.M. Koltsova, "Conditioning and Learning," in lnfancy and Early Childhood, ed. Y. Brackbill (New York: Free Press, 1967), 207-288; LP. Upsitt, "Learning Capacities of the Human Infant," in Brain and EarIy Behavior Development in the Fetus and Infant, ed. R.J. Robinson (London: Academic Press, 1969), 227-249; LP. Upsitt and H. Kaye, "The Study of Sensory and Learning Processes of the Newborn," in Clinics in Perinatalogy 4 (1977). 163-186; LP. Upsitt and J.S. Werner, "The Infancy of Human Learning Processes," in Developmental Ptasticity, ed. E.S. Gollin (New York: Academic Press, 1981), 101-133; J. Trowel!, "Effects of Obstetric Management on the Mother-Child Relationship," in The Place of Attachment in Human Behavior, eds. C.M. Parks and J. Stevenson-Hinde (New York: Basic Books, 1982), 79-94.

285E.R. Siqueland and L.P. Upsitt, "Conditioned Head-turning in Human Newborns," Journal of Developmental Child Psychology 3 (1966): 356-376.

286Gina Kolata, "Studying Learning in the Womb," Science 225 (19M): 302-303.

287A typical example of very early learning is described by Liley: "Babies who have has as few as 10 heel punctures for blood samples in the first 72 hours after birth, for weeks or months afterwards will promptly cry if you thoughtlessly grasp their foot." (Liley, "The Foetus as Personality," 201).


an ever-increasing straight line of accumulative skill. Rather, some abilities actually diminish rather than increase with time and he puts forth the thesis that it is "time for someone to present the thesis that the newborn human creature is about as competent a learning organism as he can become."288

The same can be said for the fetus at any given developmental stage, and indeed, some research has shown that prenatal intervention289 "enrichment" programs enhances the post-natal maturation process. Studies examining pre-natal "bonding" done through increased verbal communication from the mother to the fetus, found the positive effects of greater alertness and control at birth, earlier talking, independence and better concentration post-natally.290 Other research has indicated the positive effect of extra stimulation and attention on preterms even up to one year late291 and on full-term up to five.

288Lipsitt, "Learning Capacities of the Human Infant," 228, quoted by Chamberlain, Consciousness At Birth, 23.

289Brent Logan, "Infant Outcomes of a Prenatal Stimulation Pilot Study," Pre- and Peri-Natal Psychology Journal 6 (1991): 7-31; Brent Logan, "Teaching the Unborn: Precept and Practice," Pre-and Peri-Natal Psychology Journal 2 (1987): 14-17; Brent Logan, "The Ultimate Preventive: Prenatal Stimulation," in Prenatal and Perinatal Psychology and Medicine, eds. P. Fedor-Freybergh and M.LV. Vogel (Park Ridge, NJ: The Parthenon Publishing Group, 1988), 559-582; K. van de Carr, R. van de Carr and M. Lehrer, "Effects of a Prenatal Intervention Program," In Prenatal and Perinatal Psychology and Medicine, eds. P. Fedor-Freybergh and M.L.V. Vogel (Park Ridge, NJ: The Parthenon Publishing Group, 1988), 489-498; R. van de Carr and M. Lehrer, "Enhancing Early Speech, Parental Bonding, and Infant Physical Development Using Prenatal Intervention in Standard Obstetrical Practice," Pre-and Peri-natal Psychology Journal 1(1986): 20~0; R. van de Carr and M. Lehrer, "Prenatal University: Commitment to Fetal-Family Bonding and the Strengthening of the Family Unit as an Educational Institution," Pre- and Peri-Natal Psychology Journal 3 (1988): 87-102.

290E. Bowen, Pre-Birth Bonding (San Diego: Heartstart/Lovestart. 1983); E. Bowen, "A Program to Facilitate Pre-birth Bonding," in Prenatal Psychology and Medicine, eds. P. Fedor-Freybergh and M.LV. Vogel (Park Ridge NJ: The Parthenon Publishing Group. 1988), 267-271; M. Jernerg, "Promoting Prenatal and Perinatal Mother-Child Bonding: A Psychotherapeutic Assessment of Parental Attitudes," in Prenatal Psychology and Medicine, eds. P. Fedor-Freybergh and M.L.V. Vogel (Park Ridge NJ: The Parthenon Publishing Group, 1988), 253-266; 5. Lundington-Hoe and S.K. Galant, How to Have A Smarter Baby (New York: Collier-Macmillan, 1985); L Thurman, "Parental Singing During Pregnancy and Infancy can Assist in Cultivating Bonding and Later Development," in Prenatal Psychology and Medicine. eds. P. Fedor-Freybergh and M.LV. Vogel (Park Ridge NJ: The Parthenon Publishing Group, 1988), 273-282.

291H. Bender, "Psychological Aspects of Prematurity and of Neonatal Intensive Care: A Working Report," in Prenatal Psychology and Medicine, eds. P. Fedor-Freybergh and M.LV. Vogel (Park Ridge NJ: The Parthenon Publishing Group, 1988), 235-248; T. Field, "Stroking Dramatically Speeds up Preemies' Growth," Brain/Mind Bulletin (Dec 1985); L.I. Kramer and M.E. Pierpoint, "Rocking Waterbeds and Auditory Stimuli to Enhance Growth of Preterm Infants," Journal of Pediatrics 88 (1976): 297-299; E. Ray and H. Martinez, Rational Handling of the Premature Child (New York: Report to UNICEF, 1984); R. Rice, "Neurophysiological Development in Premature Infants Following Stimulation," Developmental Psychology 13 (1977): 69-76, Trowel, "Effects of Obstetric Management on the Mother-Child Relationship." 79-94.


years,292 including improved disposition, language ability and intelligence.

When considering fetal "learning" a distinction perhaps can and should be made between the observation in utero of "normal" foetal learning that might take place and attempts to condition the fetus and thus introduce "non-normal" learning into the intrauterine environment.293

Perhaps the first study that attempted to demonstrate fetal "conditioning" or habituation was that of Peiper in 1925.294 His method involved emitting the sound of a car horn several feet from a mother's abdomen during a late-term pregnancy. He noted that this resulted in marked movement by the fetus which upon repetition gradually diminished. He concluded that the fetus' thus habituated to the noise.

The study of habituation295 in newborns296 has found neonatal habituation in response to auditory,297 olfactory,298 and visual299 stimuli. Studies utilizing habituation as

292"J.H. Kennel and M. Klaus, "Early Events: Later Effects on the Infant," in Frontiers of Infant Psychiatry, eds. J. Call, E. Galenson and R. Tyson (New York: Basic Books, 1983), 7-16; M. Mustaph, "The Importance of Early Skin contact in Emotional Care," in Prenatal Psychology and Medicine, eds. P. Fedor-Freybergh and M.LV. Vogel (Park Ridge NJ: The Parthenon Publishing Group, 1988), 249-252; N.M. Ringler, MA. Trause, M.H. Klaus, and J.H. Kennell, "The Effects of Extra Post-partum Contact and Maternal Speech Patterns on Children's 10's, Speech, and Language Comprehension at Five," Child Development 49 (1978): 882-885; 5. Scarr-Salapatek and M.L Williams, "The Effects of an Early Stimulation Program for Low Birth Weight Infants," Child Development 44 (1973): 94-100.

293Hepper, "Foetal Learning: Implications for Psychiatry?" 289.

294A. Peiper, "Sinnesemp findungen des Kindes vor seiner geburt," Monatsschirft fur Kinderheilkunde 29 (1925): 237-241.

295Defined as "a decrease in response due to the repeated presentation of a specific stimulation." (R.F. Thompson and WA. Spenser. "Habituation: A Model for the Study of Neuronal Substrates of Behavior," Psychological Review 73 (1966): 16~). Another definition includes "a form of adaptive modification of behavior that involves memory, ie. learning." (Chamberlain, "The Cognitive Newborn," 43). One researcher calls habituation "the most fundamental form of learning." (P. Strarton, Psychobiology of the Human Newborn, London, J. Wiley, 1982], 235).

296Extensive reviews of neonatal and early infant habituation can be found in the following: R.E. Hinde, Behavioral Habituation (New York: Cambridge Univ. Press, 1970); W. Kessen, M.M. Haith, and P. Salapatek, "Human Infancy: A Bibliography and Guide," in Carmichael's Manual of Child Development, ed. P. Mussen (New York: Wiley, 1970) 287-444; H.V.S. Peek and M.J. Hertz, eds., Habituation, vols. 1 and 2 (New York: Academic Press, 1973).

297Bartoshuk, "Infant Neonatal Cardiac Acceleration to Sound: Habituation and Dishabituation," 15-27.

298Engen and Upsitt, "Decrement and Recovery of Responses to Olfactory Stimuli in the Human Neonate," 312-316; Engen, Upsitt and Kaye, "Olfactory Responses and Adaptation in the Human Neonate," 73.


a measure of fetal learning have proven to be the easiest to do because of their lack of any invasive procedures and thus the majority of "fetal learning" research involves habituation. Habituation of fetal heart rate300 and body movements301 in response to vibration and auditory tones has been clearly demonstrated in fetuses as early as 23 weeks after fertilization and seems to appear first in females.302 Mother study found true fetal habituation in fetuses aged 28-37 weeks.303

Since true habituation implies abilities for learning such as "a certain level of sensory competence, associative and memory capabilities",304 then it stands that those fetuses deficient in these qualities should have deficits in habituation. Research on post-natal subjects suffering from schizophrenia,305 Down's syndrome,306 and hyperactivie307 has shown this to be the case as well as studies illustrating that future cognitive abilities and skills are predictable from habituation abilities during both the fetal period308 and early infancy.309

299S. Friedman, A.N. Nagy and G.C. Carpenter, "Newborn Attention: Differential Response Decrement to Visual Stimuli," Journal of Experimental Child Psychology 10 (1970): 44-51.

300R.C. Goodlin and E.W. Lowe, "Multiphasic Foetal Monitoring: A Preliminary Evaluation," American Journal of Obstetrics and Gynecology 119 (1974): 341-357: Granier-Deferre, Lecanuet, and Cohen, "Feasibility of Prenatal Hearing Test," 93-101.

301L.R. Leader, P. Baille, and B. Martin. "The Assessment and Significance of Habituation to a Repeated Stimulus by the Human Foetus," Early Human Development 7 (1982): 211-219: Lynda S. Madison, "Fetal Response Decrement: True Habituation?" Journal of Developmental and Behavioral Pediatrics 7 (1986): 14- 20; LW. Sontag and R.F. Wallace, "Preliminary Report of the Fels Fund: Study of Foetal Reactivity," American Journal of Diseases of Children 48 (1934): 1050-1057.

302L.R. Leader, P. Baille, and B. Martin, "Foetal Responses to Vibrotactile Stimulation: A Possible Predictor of Foetal and Neonatal Outcome," Australian and New Zealand Journal of Obstetrics and Gynaecology 24 (1984): 251-256.

303L.S. Madison, SA. Adubato, and J.K. Madison, "Foetal Response Decrement: True Habituation," Developmental and Behavioral Pediatrics 7 (1986): 14-20. 304Hepper, "Foetal Learning: Implications for Psychiatry," 291.

305J.H. Gruzelier and P.H. Venebles, "Skin Conductance Orienting Activity in a Heterogeneous Sample of Schizophrenics," Journal of Nervous and Mental Disorders 155 (1972): 277-287.

306Dustman and D.A. Calmer, "Cortical Evoked Response and Response Decrement in Non-Retarded and Down's Syndrome Individuals," American Journal of Mental Deficiency 83 (1979): 391-397. 307Hutt and C. Hutt, "Hyperactivity in a Group of Epileptic (and some non-Epileptic) Braln Damaged Children," Epilepsia 5 (1964): 334-351.

308Lynda S. Madison, James K. Madison, and Susan A. Adubato, "Infant Behavior and Development in Relation to Fetal Movement and Habituation," Child Development 57 (1986): 1475-1482.


Other studies have shown this same predictability using prematurely born neonates310 during delivery.311 Habituation deficits have also been shown in fetuses' suffering from brain disorders such as microcephalia and anencephalia.312

An alternate methodology seeking to demonstrate fetal learning capabilities has used classical conditioning. Ray,313 in a study from 1932, paired vibration as a conditioned stimulus with a loud bang as an unconditioned stimulus. While no data were reported by Ray314 as to the success of his experiment, the study was repeated in 1948 by Spelt315 who reported that after 15-20 pairings of the CS (conditioned stimulus) and UCS (unconditioned stimulus), the CS alone elicited a response among 16 fetuses in the last two months of pregnancy.

More recently, similar studies have found similar results. In a series of studies by Feibo,316 fetuses ages 30-37 weeks were classically conditioned with the repeated pairing of music as the UCS with the mother's relaxation as a CS. After 24 pairings, fetuses stopped all movement upon hearing the music alone. Feijoo found that this "learning" was retained following birth for fetuses that had been conditioned between 22 and 36 weeks. These newborns stopped crying, opened their eyes and showed fewer clonic movements upon hearing the same music 6 minutes after birth.

309M.H. Bornstein and M.D. Sigman, "The Onset and Early Development of Behavior," in Manual of Child Psychology, 2d ed., ed. L Carmichael (New York: J. Wiley, 1954), 60-185.

310S.A. Rose and l.F. Wallace, "Visual Recognition Memory: A Predictor of Later Cognitive Functioning in Preterms," Child Development 58 (1985): 843-852.

311W. Bowes, Y. Brackbill, E. Conway, and A. Steinschneider, "The Effects of Obstetrical Medication on Fetus and Infant," Monographs of the Sodet" for Research in Child Development 35 (1970): 3-25.

312L.R. Leader, P. Baille, and B. Martin, "Foetal Habituation in High-Risk Pregnancies," BrItish Journal of Obstetrics and Gynecology 89 (1982): 441-446.

3l3W.S. Ray, "A Preliminary Report on the Study of Foetal Conditioning," Child Development 3 (1932): 175-177.

314Ray concluded his report with the observation that the newborn suffered "no ill effects from her prenatal education." Quoted in Hepper, "Foetal Learning: Implications for Psychiatry," 289.

315D.K. Spelt, "The Conditioning of a Human Fetus 'in Utero."' Journal of Experimental Psychology 38 (1948): 338-346.

316J. Feijoo, "Ut Conscientia Noscatue," Cahier de Sophrologie 13 (1975): 14-20; J. Feijoo, "Le Foetus Pierre et le Loup: Ou Une Approache Originale de l'Audition Prenatale Humaine," in L'Aube des Sens, eds. H. Herbinet and M.C. Busnel (Paris: Stock, 1981).


Studies examining the ability to classically condition preterms and neonates are numerous. An early study of aversive conditioning was done by Aidrich.317 After twelve pairings of a bell with pricking the sole of a neonate's sole with a pin, the bell alone produced a reflexive response. A more recent study318 on 2-week old preterms pairing the smell of ammonia with a tone produced the same result. Perhaps taking their cue from Pavlov, numerous studies conditioning neonates related to heart rate, pupillary dilation and constriction, eye blinks and sucking as well as various studies examining fetal conditioning have been done by Russian researchers from the early 1920's.319

A second category of "learning" studies has examined more naturally occurring events in the fetus' environment. For instance, several studies have examined a variety of fetal responses in connection with voices,320 particularly the mother's voice. Using 3-day old newborns as subjects, various researchers have shown that neonates will alter their sucking response (either increasing or decreasing it) in order to hear their mother's voice321 but will not do the same to hear their father's voice.322 Presumably, the constant prenatal auditory contact with the mother's voice vs. the father's voice gives rise to these preferences.

Seeking to test the memory of auditory learning from the prenatal period vs. mere familiarity with the mother's voice, DeCasper and Spense323 had pregnant women read a story repeatedly to their fetuses. Newborns were found to alternate their sucking responses to

317C.A. Aldrich, "A New Test for Hearing in the Newborn: The Conditioned Reflex," American Journal of the Disabled Child 35 (1928): 36.

318R.l. Polikanina, "The Relation Between Autonomic and Somatic Components in the Development of the Conditioned Reflex in Premature Infants," Pavlov Journal of Higher Nervous Activity 11(1961): 51.

319Brackbill and Koltsova, "Conditioning & Learning," 207-288.

320Luke refers to this possibility when he quotes Anna (John the Baptist's mother) as telling Mary (Jesus' mother) the following regarding their initial interaction while both were in the early pregnancies: "For behold, when the voice of your greeting came to my ears, the babe in my womb leaped for joy." (Luke 1:44; NIV)

321A.J. DeCasper and W.P. Fefer, "Of Human Bonding: Newborn's Prefer their Mother's Voices," Science 208 (1980): 1174-1176.

322A.J. DeCasper and P.A. Prescott, "Human Newborn's Perception of Male Voices: Preference, Discrimination and Reinforcing Value," Developmental Pschobiology 17 (1984): 481-491.

323A.J. DeCasper and M.J. Spence, "Prenatal Maternal Speech Influences Newborn's Perception of Speech Sound," Infant Behavior and Development 1(1978): 36-48.


this same story read by another women but did not respond to a novel story read by the same woman. Thus, the conclusion was that "the foetus has learned and remembered something about the acoustic cues that specified the story read to them in the womb, and conclusively demonstrates prenatal learning of acoustic cues in the womb."324

One other study325 found that the newborn children of mothers who watched a particular soap opera during their pregnancy tended to stop crying and became alert when the theme song of the program was played. Infants of women who had not watched the same program showed no response to the music.

Numerous other studies have focused on the abilities of newborns to learn. For instance research has illustrated neonatal abilities to imitate behavior,326 to change sucking behavior in response to negative and positive pressure on the gums,327 In response to regular or blunt nipples,328 and in response to plain and sweet fluids.329 While these studies were quite simple, newborns have shown quick learning ability even in the mastery mastering of complex and confusing sets of contingencies and even continue to learn when these contingencies were reversed.330 Associated with these learning tasks, newborns have been found to have good memory associations, including procedural memory,331 semantic memory332 episodic memory333 and emotional are affect memory.

324Hepper, "Foetal Learning: Implication for Psychiatry?" 290.

325Peter G. Hepper, "Foetal 'Soap' Addiction," Lancet 1(1988): 1347-1348.

326T. M. Field, R. Woodson, R. Greenberg and D. Cohen, "Discrimination and Imitation of Facial Expressions by Neonates," Science 218 (1982): 179-181: A. Meltzoff and M.K. Moore, "Imitation of Facial and Manual Gestures by Human Neonates," Science 195 (1977): 75-78: A. Meltzoff and M.K. Moore, "The Origins of Imitation in Infancy: Paradigm, Phenomena, and Theories," in Advances in Infancy Research, Vol.2, eds. L.P. Upsitt and C. Rovee-Collier (Norwood, NJ: AbIex, 1983), 265-301.

327A.J.Sameroff, "Learning and Adaptation in Infancy: A Comparison of Models," in Advances in Child Development 7 (1972): 170-214.

328J. Brown, "Instrumental Control of the Sucking Response in Human Newborns," Journal of Experimental Child Psychology 14 (1972): 66-80.

329K. R. Kobre and L.R. Upsitt, "A Negative Contrast Effect in Newborns," Journal of Experimental Child Psychology 14 (1972): 81-91.

330Siqueland and Lipsitt, "Conditioned Head-Turning in Human Newborns," 356-376.

331 Defined as "retention and recall of learned connections between stimuli and responses.' (Chamberlaln, "The Mind of the Newborn," 16, quoting E. Tulving, "How Many Memory Systems are There?" American Psychologist 40 [1985]: 385-398); C. Rovee-Collier, "Baby's Memory," American Psychological Association Monitor (Oct 1985): 25.

332Defined as "internal states of meaning not perceptually present . . . a conscious form of cognition." (Chamberlain, "The Cognitive Newborn," 59.); J.A. Ungerer, LR. Brody, and P.R. Zelazo, "Long-term Memory for Speech in 2-4 Week-old Infants," Infant Behavior and Development 1(1978): 177-186; LR. Brody, P.R. Zelazo, and H. Chalka, "Habituation-Dishabituation to Speech in the Neonate," Developmental Psychology 20 (1984): 114-119.

333Defined as "various forms of recall of specific episodes in the past." (Chamberlain, "The Cognitive Newborn," 59.); J.S. Werner and E.R. Siqueland, "Visual Recognition Memory in the Preterm Infant," Infant Behavior and Development 1(1978): 79-94; A. Slater, V. Morison, and D. Rose, "Visual Imagery at Birth," British Journal of Psychology 73 (1982): 519-525.

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