The first meeting
Entering the home where a new born lives give me a sense of accessing the intimacy of a woman’s womb. Lights are dimmed, my eyes take time to slowly adjust to the darkness and to start revealing my new surroundings, quiet whispering voices and the sound of a new baby alternately resting and feeding against his mother’s chest. Today, I came to meet her; the new mother, to listen to her version of their birth story, remaining aware that baby also has his own story to express. I take a seat, start listening; grounded, keeping an inner sense of my own midline so I can fully be present to take in the story she is sharing with me. Words are spoken, tears slowly running down her cheeks.
Let’s take a break and breath,
Acknowledging what has happened,
Eyes resting on the new born, asleep.
“Giving birth and being born brings us into the essence of creation, where the human spirit is courageous and bold and the body a miracle of wisdom” (Hariette Hartigan)
As I met Marcelina for the first time, she agreed to embark on a journey to explore the effects of Biodynamic Craniosacral Therapy as she was transitioning from woman to mother, stepping onto the unknown of what it is like to look after a newly born human being. On our first meeting she spoke of her baby’s passage from womb to earth and it is her story that inspired me to draw this research. It is part of her story as well as Iza’s, Ola’s, Olga’s and my own which will be shared here.
No birth can ever be identical, each baby has its own story when it comes to joining our world – I remember my midwife speaking these words a few minutes after I started holding my third baby in my arms. It steered within me, as his mother, his vessel into our world. These words then also become relevant to how mothers experience childbirth. Researchers have shown that a third of women experience traumatic childbirth (1) while 4% will develop PTSD (2) following the event.
What are the possible causes of traumatic childbirth? What are the implications for mum and baby? How can Biodynamic Craniosacral Therapy potentially support women whom experienced traumatic childbirth? Those are the questions I will endeavour to give an answer to in this research.
CHAPTER 1: Stress, Trauma and Childbirth
I would like to start by introducing the notion of stress and trauma to the reader, so we can get a better sense on how to differentiate one from the other. I will then present the knowledge around childbirth trauma, its causes and consequences before depicting a portrait of how childbirth trauma is currently addressed in a hospital environment in Poland.
Stress and Trauma
It isn’t unusual to experience some degree of stressful situations across the day. You may have been late for an appointment, had a tensed conversation with your boss or left dinner on the stove for too long. Our bodies are physiologically designed to respond to stress and stress isn’t always negative, it can also be transformative and have positive consequences in shaping our lives. However, when a stressful and unpleasant situation occurs and overwhelms a person’s system it is when the term trauma can be introduced. Some examples of traumatic experiences may include: accident, surgery, losing a loved one, shocking news and so on.
For the purpose of this study, I would like to reference Franklyn Sills definition of the Stress Response (3)
“There are four basic stages to the stress response:
- The ideal and resourced state
- Orienting Response
- Fight or Flight
- Overwhelm Shock
- The ideal and resourced state: It is a fully resourced, relaxed and present-time state. We can calmly walk into the forest and appreciate the sunlight and smells…we can relate to our friends and can use our social nervous system to get our needs met. Our neuroendocrine and autonomic nervous system are poised in fluid homeostatic balance.
- Orienting response: A loud noise occurs and you find yourself momentarily freezing as you orient around you – seeing, hearing, sensing for danger. This state is called active alert and can be described as a calm state of heightened awareness and mental clarity to orient to possible danger.
- Fight or Flight: This term was coined by Hans Selye in the 1930’s and is our most basic response to stress, danger and overwhelming situation. Here the parasympathetic nervous system which mediates arousal, vigilance and action, surges along with increases in certain hormones especially noradrenaline and adrenaline. Energies move to the periphery, our body is mobilised for action, ready to fight or flee…. Once the stress is successfully dealt with, the body physiology is designed to shift smoothly back to a baseline state of homeostatic balance.
- Overwhelm Shock: If our intentions to protect are overwhelmed and the fight or flight response is thwarted, then we may be cast into a deeply protective shock response. The parasympathetic nervous system surges and the person is cast into protective, dissociative, freezing states in order to protect the organism from further pain… Ideally, as a person comes out of shock states, he has the opportunity to resolve the underlying traumatic cycling. The sympathetic charge may be mobilised and cleared by trembling, shaking and emotional expressing while the person remains resourced in present-time awareness.”
Birth: an intimate dance between the baby and his mother
The time has come… first signs of contractions.
Baby started its final dance into the womb to transition into his new life. Just like a rite of passage, he is honouring his temple and getting ready to farewell his life in utero. Love hormones; oxytocin, are released into his mum’s body. Contractions are getting stronger, but each pause is a chance for him to get closer to his new life to deepen the bound with his mum but also to resource and find his way down the birth canal.
Although birth can be considered a natural act of life, researchers have observed an increase in the number of women experiencing childbirth as a traumatic event. Paulina Mostynska (4) explains it by the fact that in the last 70 years, births have been transferred to hospitals and have become a medical intervention. Consequently, there has been an increase in unnecessary medical interferences in the unfolding of births (5) which may lead to a sense of overwhelm or shock for mums and babies.
“Only 5-10% of births actually require medical intervention” (Cherionna M.Sills (7))
Once mum is holding her baby the traumatic childbirth experience is put aside and stored in the body so she can look after the newly born. In cases of home childbirths or hospital childbirths where mum has access to her resources, isn’t time constraint and is feeling held in a neutral and safe environment, she may start a process of self-regulation.
What can be regarded as a Traumatic Birth?
Just like humans don’t experience stress in the same way; women will experience traumatic childbirth differently, which may be linked to earlier experiences in life going as far as prenatal and perinatal experience, which shaped the capacity to regulate the nervous system or previous unresolved traumatic stress experiences. There are still very few studies around childbirth trauma but according to the information currently available, the birth trauma association UK (6) was able to give a non-exhaustive list of factors which may lead to experiencing childbirth as traumatic. I have therefore listed those factors hereunder according to their data and in 80% of cases the trauma is a result of medicalised births, when the woman is put into a hostile environment where there isn’t a place for following the wisdom of the body but to deliver a baby according to scientific recommendations.
Before we look into the list of recognised factors of birth trauma, it may be worth acknowledging that some women will have never visited a hospital until they had to give birth, regarding this environment as a place to look after illnesses what somehow activates a stress response and slow down the labour.
“I really wanted a home birth, I never liked hospital. In a way I think I was afraid of hospitals and home birth was the only option for me to feel completely safe” Marcelina
Here are some factors listed by the birth trauma association which I would like to address as part of this study:
Lengthy labour or short and very painful labour : “We arrived at the hospital and the contractions slowed down. My water broke 12 hours prior, so I was given synthetic oxytocin. The contractions intensified; the pain was unbearable… there were no stops. I thought I wouldn’t make it, I thought I could die” Olga, 1-week post-partum
Feelings of loss of control
High levels of medical intervention
Emergency caesarean section
Impersonal treatment or problems with staff attitudes “Once I arrived at the hospital, I met the midwife in charge and I knew… I knew I wouldn’t give birth with her. A friend warned me she was unpleasant, maybe unhappy with her job. I entered a freeze state, the contractions stopped and I was able to delay the delivery of the baby until the change in shifts, until another midwife arrived and could hold me to deliver my baby” Iza, 3 weeks post-partum
Not being listened to “I was isolated, in a small room, plugged to some equipment to measure the baby’s heartbeat. The pain was horrible, there was blood streaming down my legs but the person in charge ignored me, ignored my pain until I broke down. I was then dilated by 8 cm and finally another midwife came into the room and moved me to a delivery room where my husband could finally be with me” Marcelina, 4 weeks pots-partum
Lack of information or explanation
Lack of privacy and dignity
What are the consequences of traumatic childbirth?
“Both the beautiful initiatory potential of birth and the unnecessary trauma tend to retreat to the unconscious mind, as the focus turns to enjoying or coping with a newly arrived family member” (Cherionna Menzam Sills (7))
As we saw earlier, a third of women have reported they had a traumatic childbirth which can affect their post-partum period in different ways. The trauma is however dealt with differently for each of these women while some women may have initiated a process of self-regulation not long after childbirth, some women may feel the stress response still cycling into their system in the initial stage of their post-partum which with time and the right level of support will find resolution within the first 6 months after birth. However, a small percentage were reported suffering from post-traumatic stress disorder linked to childbirth.
Post-traumatic stress disorder as a result of childbirth
I will once more refer to the same source, the birth trauma association UK (6), which presents a list of symptoms resulting from Post-Traumatic Stress Disorder triggered by childbirth:
- Re-experiencing the traumatic event through flashbacks, nightmares or intrusive memories. Feeling distressed and panicky.
- Avoiding anything that reminds the trauma. This can mean refusing to walk past the hospital, or avoiding meeting other women with new babies.
- Feeling hypervigilant: constantly alert, irritable and jumpy. Worrying that something terrible is going to happen to the baby.
- Feeling low and unhappy. Feeling guilty and blaming oneself for the traumatic birth. Difficulty remembering parts of the birth experience.
Those symptoms will then trigger anxiety and isolate the new mum as she feels misunderstood. This in consequence may lead to postnatal depression (although a traumatic childbirth isn’t the only cause of postnatal depression). On the other hand, it may also delay or suppress the essential bonding time with the new born baby, fundamental to the early regulation of baby’s social engagement system. Unfortunately, as mum’s nervous system remains on alert, she may not feel capable to be present for the baby and give him/her the love she would like to or to acknowledge and accept the love the baby wants to give her. As a result, the baby may in return not be able to recover from his/her own birth story and stress hormones may keep him/her on high alert.
Childbirth trauma in Poland: what is the current knowledge and how is it addressed?
Paulina Mostynska, midwife, has shared her view on this topic (4). She is aware of the problem, not only for mothers but for the whole family and the midwife who is assisting the birth. She denounces the inconsistencies between hospitals and staff attitudes in the hospital environment. On the other hand, she recognises that the awareness and acceptance of home or natural births amongst the medical staff and families have considerably improved in the last 20 years. She also confirmed that in the last years, maternity units have started employing more specialist (psychologist, physiotherapist, osteopath) to look after the mums and newly born baby. (Full transcript of the conversation can be found in the appendix)
Through the case studies I was able to carry, I was able to identify that woman want to be more prepared to avoid as little medical interventions as possible, but as Paulina explained there are still inconsistencies across hospitals in relation to the use of what could be deemed unnecessary medical interventions. With the growing awareness around birth trauma, information is more readily available on the internet and maternity units may now host different health specialist to support the birthing mother before she returns home. However, as I could observe with the women I worked with and my own experience, women may not always show symptoms of the stress response cycling through their body and may not reach out for help thinking their emotions are linked to hormonal readjustment and exhaustion. In the next chapter I will present a phenomenological study on the effects of Biodynamic Craniosacral Therapy on women who recently gave birth and, in some cases, may have suffered from stressful / traumatic childbirth.
Biodynamic Craniosacral Therapy: a technique to address trauma related to childbirth
“Becoming pregnant and giving birth require resources to meet the natural stresses of constant changes” (Cherionna Menzam Sills (7))
In this chapter, we will discuss the aspects of Biodynamic Craniosacral Therapy, which can make a significant difference to the way a woman can either prepare herself for childbirth but also to overcome the unexpected and release emotions linked to what could be deemed a traumatic birth. I am hereunder presenting a reflection of my experience, as a therapist, but also as a patient journeying through pregnancy, birth and post-partum.
Biodynamic Craniosacral Therapy as a tool to self-regulate
Sophie Rieu, Biodynamic Craniosacral therapist talks on her blog about our connectedness with our world and how this can shape our own connection with our being (8): “Everything and every living being resonate and speak to our senses all the time on this planet. Instead of opening our senses to this resounding web, we have dissociated from it, floating away from the Earth’s vulnerable wonders with our separated selves.”
By separating with ourselves, we have slowly forgotten to sense our body, to attune to its signals and turned away from its intuition – the connectedness with our ancestors. In doing so, we have lost the ability to connect to our inner resources for our bodies to self-regulate.
In the principles of Biodynamic Craniosacral Therapy Volume 5, Michael J Shea, PhD, talks about the importance of self-regulation (9) “Self-Regulation develops into an ever-widening spiral of potential health and wellbeing. To self-regulate is to develop more and more body awareness of heart rate, breathing, arousal and attention states in order to modify them as quickly as possible when not in a normal range of wellbeing”.
By offering an unconditional presence, from a fully resourced and grounded state, a Biodynamic Craniosacral therapist can offer to its clients the capacity to get in touch with their body sensations, to find their resourceful place and help regulate their autonomic nervous system responses. As the work progresses, previous stress stories may be released, clouds will dissipate, reorganisation can occur around the midline, clarity will emerge to then fall into the deep ocean of wholeness. Clients may then feel more resourced, more connected with themselves, with others and the nature, stimulating their ability of self-regulation so they can fully experience life in a resourced state.
According to this, there are the 3 components that could benefit women before and after birth: connection, resource, self-regulation ,which we will explore hereunder.
In foundations in craniosacral biodynamics (10), 2008, Franklin Sills writes about the role of the relational field during therapeutic work to enable the sense of connectedness to the self and the whole “A conjoined being to being field within which it is acknowledged that both practitioner and client are on a mutual journey, it is in this kind of field that client can settle out of conditioned forms into a resonant state within which primary respiration can emerge”. With the help of this work, the woman may feel more connected in a sense that it isn’t her and a baby, it is one being. She may be able to attune to her intuition, to her long line of ancestors and therefore be able to create this safe environment where birth is expected with love. In return the baby will feel connected, accepted and loved and develop strong and healthy foundations to future bounding and attachment.
Here are my notes of the second session with Ola (4 weeks post-partum): “At first the forces at play showed different patterns in her body, reflecting what she herself described as weak areas. Progressing through this second session together, there was a sense of tissue melting away and an abundance of unconditional love for her baby but also for her baby-self which arose. Her field then grew to include her baby who was lying down with his dad a few metres away, creating an undeniable oneness. During the session she found it difficult to concentrate and her mind was rather focusing on the different noises she was observing in the room but she wrote to me that same evening to explain that this session brought her even closer to her baby, their systems felt more attuned, she intuitively knew what he needed and it gave her the confidence she needed as a new mother.”
“Resources are the aspect of a person’s make up that support and nature the person’s welfare and ability to adapt to change and traumatic experience”, “When a person experiences trauma, the quality and availability of resources are critical” Franklin Sills (9).
As a practitioner, I understood I needed to support women who experienced stressful childbirth in gaining a felt sense of their inner resources. I noticed that with the stress-response which was still cycling in their own system they sometimes didn’t feel capable or strong enough to look after themselves. They felt overwhelmed by motherhood, just as they felt overwhelmed by their childbirth experience. By slowly offering to reconnect with their body, they could regain the sense of connectedness and let go of what they no longer needed and be present. During a session I would offer to explore different kind of resources, external or internal by associating a felt sense in the body.
I am a quoting here an example of a resource mentioned by one of my case study. Marcelina, Session 3, 6 weeks post-partum exploring external resources “I see baby, husband and myself laying in the grass of our countryside home. It gives me a sense a warmth and unconditional love and happiness”
Here are my notes of my fourth session with Olga, 9 weeks post-partum.
“ She explained to me that she still feels a lot of anxiety and it triggers a sense of guilt that this may have consequences on the baby’s wellbeing. She cries regularly and doesn’t have the strength to take a shower, to do anything for herself. Her skin tone looks pale, her eyes asking for help. When she brings attention to her body all she can sense is this ball of anxiety siting in her solar plexus; present since she came home with the baby. I invited her to sit down and we did a meditative explorative exercise for 20 minutes so she could gain a felt sense of each part of her body. At the end when I asked her which place in her body would give her a sensation of calm and safety, she said it is her heart. I asked her to keep this felt sense and to move to the treatment table where I held her in an integrative hold until the baby started to cry. She said the cries made her feel anxious so we did a shuttling exercise for a few minutes to alleviate her anxiety by connecting with the felt sense of her heart resource. Once she took the baby over, I suggested she keeps a sense of her heart centre and visualise this felt sense all over her body as she holds her baby and looks into his eyes”
I met Olga a week after that session, it was wonderful to witness her metamorphosis. The anxiety had reduced, she mentioned feeling a stronger connection with her baby and enjoying every moment of it even the night feeds which she used to dread before.
On a personal note, I worked on my sense of felt resources as I was 5 months pregnant with my third child. This was new to me and I was exploring this as part of my BCST studies. I kept this awareness as I was navigating a difficult pregnancy filled with nausea until the birth. Although this birth was the most difficult, I recovered more quickly from it, thanks to a self-regulation process which I will describe hereunder, I didn’t keep any negative emotions and navigated a post-partum period in a blissful state. If I had to describe in a few words what this period looked like I would say that we felt whole, interconnected as one being, living in the present moment where the notion of time, day, space felt irrelevant.
Connectedness + Resources = Self-Regulation
In his book, “In an unspoken voice” 2010 (11), Peter Levine shared with the reader his personal experience of trauma as he was involved in a car accident while he was crossing the pedestrian path. A totally unexpected event for which he kept minor scars but didn’t suffer from PTSD due to his body starting a self-regulation process as he was being driven to the hospital in an ambulance but also to his caregivers at the time who held him in a safe and compassionate field. Here is how he defines Self-Regulation: “The capacity for self-regulation is what allows us to handle our own states of arousal and our difficult emotions, thus providing the basis for the balance between authentic autonomy and healthy social engagement. In addition, this capacity allows us the intrinsic ability to revoke a sense of being safely at home within ourselves, at home where goodness resides”
What is the link between BCST and self-regulation? From my experience as a therapist and patient, I was able to recognise that the sense of connectedness and felt resource were able to provide the safety the body requires to self-regulate. By working on both aspects with BCST, there is a possibility for healing to emerge from a traumatic childbirth which may start not long after the event if the woman is held in a safe environment to fully express what she needs to release.
I am sharing here a view into my most recent childbirth story and what the process of self-regulation looked like for me:
“Contractions intensified, my eyes have been closed for what I feel a long time now, I am not sure what is happening but baby makes a first attempt to emerge from the birth canal, it doesn’t work, a second attempt and once more it doesn’t work. His heartbeat starts to slow down, I am told to change position. I need to make eye contact with my husband and I revert to my mother tongue unintentionally to ask him what is happening and to ask him to stop everything. I have to change position again, I breath, I try hard but I can’t move my body anymore, it feels as if I lost all my strength or my capacity to command my body. My husband carries me, holds the full weight of my body. The pain intensifies to a point that I am not sure if I am not about to die, I scream but the caring eyes of a new midwife come into my sight, she gets hold of my soul and I start reconnecting with my body and finally baby arrives… The notion of time has vanished but here is the baby, resting on me suddenly my body starts to tremble, first my teeth are clenching and then it’s my whole body. At that point I don’t know what is happening, I ask my husband to hold the baby because I can’t but also don’t want to stop the shaking, I am offered additional blankets but no I don’t feel cold and after what felt like 15 minutes the trembling starts to slow down to finally come to a stop. It is my Biodynamic Craniosacral Therapist whom I met 2 months later who helped me understanding that my body was self-regulating after what it might have felt like an overwhelming experience.”
BCST and trauma resolution in the context of childbirth
A BCST practitioner has the capacity to orient to different phenomena as he/she holds a client suffering from traumatization and nervous system activation. Franklin Sills identified them as : Orientation to dynamic stillness, tidal bodies, fluid body, potency, central nervous system motility… There is one of these phenomena I was able to orient to and observe its potential; stillness which I will describe hereunder.
As part of this study, one of the phenomena I was able to observe on each of the women I worked with is stillness. Often their systems would feel vibrant where it would be easy to perceive their fluid body and the potency of the fluid tide, which will then move into a still point or stillness. In this state the body was able to re-connect with its resources, initiate autonomic clearing where new neural pathways would develop enabling the client to be more embodied rather than re-traumatised. Through this process, the sympathetic cycling is being cleared and the memory of the trauma has the potential to shift from pain to compassion and childbirth can then become a unique transformative experience.
To explore this aspect, I would like to share some notes of my work with Marcelina.
Session 1, (4 weeks postpartum): “She shared her birth story with me, what I heard were the words : isolating, helplessness, sadness, vulnerability. Then a sense of calm when she held the baby but quickly this had to be put away because the baby has an infection, panic. Hospital stays made it worst, no sleep, very low mental health, a lot of tears, she began her healing with a psychologist at the hospital and it helped her to start sharing her story. 4 weeks later, she feels sad when thinking about the birth and keeps a sense of guilt – we talked for 2 hours, no session work, I offered presence and unconditional acceptance as she shared her story”
Session 2 (5 weeks postpartum): “Sense of fluid tide, midline seems absent around the diaphragm. Held her occiput for the first session, quickly dropped into stillness, sense of her whole body resting and recharging. Baby was asleep in another room and as he woke up, he greeted his mum with the biggest smile full of love and happiness.”
Session 3 (6 weeks postpartum): “Before the session, she explained experiencing pain on her left side of her belly. A lot of patterns showed around her solar plexus. Fulcrum point was felt as I held her psoas muscle, big spiral until the ball started sinking down. Offered augmentation skills, the fluid tide resumed and stillness emerged as an opportunity for something to clear. We quickly had to finish the session as the baby was entering home with his dad crying. ”
Session 4 (7 weeks postpartum): “At the start of the session, she explained that she felt very good and suggested she is happy for me to look after another mom if I need to, this for me was a sign she felt more resourced. Session with baby, the midline has gained clarity in comparison to our first session, feeling of a spine/snake floating above the water. We had a recap at the end of this session, sessions are helpful, it resources her, gives her this time to look after herself. She is more at peace with her birth but has a sense of longing for the birth she planned and couldn’t have. Blossoming into motherhood”
I have described here our first 4 sessions together and we can witness the effects of the therapy although still at an early stage. We carried on our work for another 4 sessions with the baby. The potential of the stillness that emerged, gave her the possibility to connect to her resources and to clear any sympathetic charges. Her midline clarified as stress memories would dissipate. When I first met her, she said she was a very bad sleeper, the smallest light or noise would keep her awake and this is why she also couldn’t sleep in the hospital despite being exhausted. After 2 months of our work together, she can easily transition from awake to asleep stages as she feeds the baby throughout the night. I could conclude that BCST offered her the doorway to be more embodied and resourced and she can now take full advantage of the oxytocin released into her body to regulate her sleep patterns to baby’s, subconsciously transforming the birth experience into a transformative journey into motherhood.
Through this phenomenological study, reflecting on my experience, I was able to put in practice the knowledge and skills of Biodynamic Craniosacral Therapy in the context of traumatic childbirth. I am thankful to Marcelina, Ola, Iza and Olga for offering me their trust in this search process. These 4 women showed me the power that a woman can hold, particularly when it comes to birthing and caring for a new born baby. In some cases, the birth didn’t unfold as they planned activating a stress response, but their will to get better so they can nourish their child with unconditional love, was a proof of their first step towards their healing journey.
As I take a step back, I understand that childbirth should be given the space to unfold naturally but as Paulina mentioned, since hospitals took over this act of life there is still some work to do for professionals to trust the process rather than interpreting it in medical terms and maybe sometimes reproducing their own birth story by intervening too early.
In return the woman should also feel more prepared, mentally she may have read all the relevant books for the kind of birth she desires and physically attended preparation workshops to childbirth, learning to breath, learning about postures and so on. Although those preparations are of a great importance, what I was able to identify in this research is the need for the birthing woman to feel connected and therefore trusting the wisdom of her body, to feel resourced and to be able to access those felt resources when her mind has to surrender and consequently start a process of self-regulation once the birth is over.
As the family enters home, a huge period of adaptation awaits them. BCST offers the potential for women to be held, to unfold the whole birth story and release unnecessary emotions linked with childbirth and enable a seamless transition from woman to motherhood. As the whole family field feels more resourced, nurtured, the autonomic nervous system can adjust to the whole field and self-regulate with ease creating a lifelong of health potential.
- Ayers S, Pickering AD. Do women get posttraumatic stress disorder as a result of childbirth? A prospective study of incidence. Birth Berkeley Calif. 2001;28(2):111–8. https://doi.org/10.1046/j.1523-536X.2001.00111.x.Return to ref 3 in article
- Ayers S, Joseph S, McKenzie-McHarg K, Slade P, Wijma K. Post-traumatic stress disorder following childbirth: current issues and recommendations for future research. J Psychosom Obstet Gynaecol. 2008;29(4):240–50. https://doi.org/10.1080/01674820802034631.
- Foundations in Craniosacral Biodynamic Volume 2, Franklyn Sills, 2012
- Paulina Mostynska, Midwife, Wroclaw (Interview in the appendix)
- Davis Floydd 1992
- Cherionna Menzam Sills – Spirit into form 2021
- Biodynamic Craniosacral Therapy, Volume Five, Michael J. Shea, Ph.D. 2013
- Foundations in Craniosacral Biodynamic Volume 1, Franklyn Sills, 2012
- In an unspoken voice, Peter A. Levine, 2010
autor: Aurelie Sieraczek