Dr. Sara O'Byrne:

I thank the Chairman and members for the opportunity to meet with them today. I am a clinical psychologist working with young people who have experienced trauma and adversity, within a specialist setting. I welcome the opportunity to disseminate information in respect of research and best practice and to have this knowledge, in turn, shape and influence thinking in respect of the mother and baby home institutions payment scheme.

The committee may be aware that I was prompted to make contact with the Minister, Deputy O'Gorman, in respect of the scheme in November 2021. I, alongside co-signatories across disciplines working in the area of trauma, raised concerns regarding the current iteration of the scheme. These concerns stemmed from a knowledge base in respect of the impact of early trauma and its consequences throughout the lifespan, as well as the exclusion of certain cohorts of individuals from the scheme. In considering the impact from the perspective of early childhood trauma, this is not to negate the profound experience for the mother. We know it has been a profoundly harmful experience for many women to have given birth and resided in a mother and baby home. Indeed, we cannot separate maternal experiences from babies' experiences, given how important and intertwined the relationships are.

Donald Winnicott, one of the earliest proponents of developmental psychology in the early 1900s, stated, "There is no such thing as a baby. There is a baby and someone." Babies are born helpless and utterly dependent on another for survival. The context into which babies are born matters, as does the pre-birth context. Experiences are required to shape the potential of the child. The brain has a timetable for development, if you like, with different areas developing at different stages. Disruptions of experiences at different stages can lead to deficits in later development. For example, high maternal levels of cortisol, a stress hormone, during pregnancy will influence functions controlled by the brainstem for children, such as sensory processing, sleep, feeding and physiological functions such as cardiovascular and temperature regulation. When we reflect on pervasive experiences of shame, stress and trauma that are at the heart of the many stories women have told of their experiences in mother and baby home institutions, we would naturally expect higher levels of stress during pregnancy as a result.

Of course, their babies, who are now adults, will not be able to narrate their experiences, but many children born in mother and baby home institutions will experience sensory and physiological difficulties well into adulthood.

Apart from the impact ofin uteroand birth experiences, we must also consider what babies need after birth. Babies need to be rocked, held, soothed and comforted in predictable and safe ways for optimal relational growth to happen. They need caregivers who themselves are psychologically well and have a sense of safety to adequately care for and meet the needs of their babies. Infancy is a crucial period for attachment, in which the brain organises around expectations of safety and comfort within relationships. Daily experiences of caregiving shape the child’s later attachment system. Good enough caregiving, by which I mean attuned, present and responsive care, enables the baby to learn that the adults and the world are safe and predictable. The converse is also true. If babies are not responded to in a way that promotes safety and care, they learn to organise their own behaviour and emotions to respond to an unpredictable, unsafe or sometimes frightening environment. As such, they learn that others are not reliable and trustworthy to meet their needs. Institutional environments such as the mother and baby homes are suboptimal and indeed often harmful environments for relational growth. Thus, babies who have been raised in institutional settings are less likely to present with security of attachment and more likely to have developed strategies such as inhibition and suppression of emotional needs by withdrawing or exaggeration of emotional responses in order to have their needs met. Without intervention, these patterns tend to persist into childhood and, indeed, adulthood, and form the bedrock for all subsequent relationships.

It was only in the 1990s that we began to look at the impact of separation of mother and baby soon after birth on later development, something Nancy Verrier called the “primal wound”. She reflected that early separation can lead to profound experiences of loss, mistrust and difficulties in relationships with others later in life. Yet in many ways, the impact of this separation is often denied. The assumption is that babies do not remember, and therefore this does not matter. Of course, we know that the process of moving from one caregiver to another, such as through adoption, which was often an outcome for children born in these institutions, is a profoundly stressful one, even if the environment is ultimately an enriching and positive one. All of these experiences of separation and loss leave a lasting mark and shape how those who have experienced them navigate all future relationships.

To conclude, the message from research on childhood trauma is clear. The earlier the impact of trauma, the more pervasive and long-lasting the consequences. This is due to the rapid nature of brain growth and development at this time and the crucial nature of experiences to shape brain functioning and attachment. Impact is not time-dependent, but rather is related to the nature and quality of experiences and how these shaped later development. All who passed through mother and baby homes have been affected and these experiences will have shaped and influenced childhood and adult development. Indeed, we know that adults who experienced childhood trauma are much more predisposed to a range of both physical and mental health needs in adulthood, not to mention relational difficulties.

Recovery from early trauma is possible with the right ingredients. These are acknowledgement of harm, provision of tailored therapeutic supports, love and validation of experiences. We need to look towards the future while also orienting to the past, and recognise the harms caused by inadequate care to mothers and babies. Rupture and repair is at the heart of all good relationships. This Bill offers the potential to be a moment of repair in the lives of generations of families who were and continue to be impacted by the mother and baby homes. It can serve as an act of validation of people’s lived experiences and support genuine recovery, but revisions will be required to encapsulate all of those affected, not just some.