Osteopathy for pregancy and newborn
The birth is certainly the finest and most moving moment of life, yet a few people know the mechanism and the difficulties resulting from a difficult birth. The mechanism of childbirth may have consequences for the life of the child. Over and above newborns have anatomical and physiological specificities, their bodies are completely immature.
Mechanism of labor
The ability of the fetus to successfully negotiate the pelvis during labor involves changes in position of its head during its passage in labor. The mechanisms of labor, also known as the cardinal movements, are described in relation to a vertex presentation, as is the case in 95% of all pregnancies. Although labor and delivery occurs in a continuous fashion, the cardinal movements are described as 7 discrete sequences, as discussed below.
The widest diameter of the presenting part (with a well-flexed head, where the largest transverse diameter of the fetal occiput is the biparietal diameter) enters the maternal pelvis to a level below the plane of the pelvic inlet. On the pelvic examination, the presenting part is at 0 station, or at the level of the maternal ischial spines.
The downward passage of the presenting part through the pelvis. This occurs intermittently with contractions. The rate is greatest during the second stage of labor.
As the fetal vertex descents, it encounters resistance from the bony pelvis or the soft tissues of the pelvic floor, resulting in passive flexion of the fetal occiput. The chin is brought into contact with the fetal thorax, and the presenting diameter changes from occipito-frontal to suboccipito-bregmatic for optimal passage through the pelvis.
As the head descends, the presenting part, usually in the transverse position, is rotated about 45° to anteroposterior (AP) position under the symphysis. Internal rotation brings the AP diameter of the head in line with the AP diameter of the pelvic outlet.
With further descent and full flexion of the head, the base of the occiput comes in contact with the inferior margin of the pubic symphysis. Upward resistance from the pelvic floor and the downward forces from the uterine contractions cause the occiput to extend and rotate around the symphysis. This is followed by the delivery of the fetus' head.
Restitution and external rotation
When the fetus' head is free of resistance, it untwists about 45° left or right, returning to its original anatomic position in relation to the body.
After the fetus' head is delivered, further descent brings the anterior shoulder to the level of the pubic symphysis. The anterior shoulder is then rotated under the symphysis, followed by the posterior shoulder and the rest of the fetus.
Descent: As the fetal head engages and descends, it assumes an occiput transverse position because that is the widest pelvic diameter available for the widest part of the fetal head.
Flexion: While descending through the pelvis, the fetal head flexes so that the fetal chin is touching the fetal chest. This functionally creates a smaller structure to pass through the maternal pelvis. When flexion occurs, the occipital (posterior) fontanel slides into the center of the birth canal and the anterior fontanel becomes more remote and difficult to feel. The fetal position remains occiput transverse.
Internal Rotation: With further descent, the occiput rotates anteriorly and the fetal head assumes an oblique orientation. In some cases, the head may rotate completely to the occiput anterior position.
Extension: The curve of the hollow of the sacrum favors extension of the fetal head as further descent occurs. This means that the fetal chin is no longer touching the fetal chest.
External Rotation: The shoulders rotate into an oblique or frankly anterior-posterior orientation with further descent. This encourages the fetal head to return to its transverse position. This is also known as restitution.
At this point of development, the child`s skull is not yet ossified, it is cartilaginous, malleable, and can deform to accommodate modeling and undergoes during the childbirth.
The skull`s bones are constituted by two essential parts, the bones of arch and those of base.
The bones of the base are made of cartilage, dense and strong, while the bones of the vault are membranous, thinner disposed like plates separated by the membranes that are fontanelles.
Fontanelles are soft spots on a baby's head which, during birth, enable the bony plates of the skull to flex, allowing the child's head to pass through the birth canal. The ossification of the bones of the skull cause the fontanelles to close over by a child's second birthday. The closures eventually form the sutures of the neurocranium. Other than the anterior and posterior fontanelles, the mastoid fontanelle and the sphenoidal fontanelle are also significant.
The skull of a newborn consists of five main bones: two frontal bones, two parietal bones, and one occipital bone. These are joined by fibrous sutures, which allow movement that facilitates childbirth and brain growth.
At birth, the skull features a small posterior fontanelle, an open area covered by a tough membrane, where the two parietal bones adjoin the occipital bone (at the lambda). This fontanelle usually closes during the first several months of an infant's life. This is called intramembranous ossification. The mesenchymal connective tissue turns into bone tissue.
The much larger, diamond-shaped anterior fontanelle where the two frontal and two parietal bones join generally remains open until the child is about two years of age, however, in cleidocranial dysostosis it is often late in closing or may never close. The anterior fontanelle is useful clinically. Examination of an infant includes palpating the anterior fontanelle.
Two smaller fontanelles are located on each side of the head, more anteriorly the sphenoidal (between the sphenoid, parietal, temporal, and frontal bones) and more posteriorly the mastoid (between the temporal, occipital, and parietal bones).
The newborn skull during the labor
The area of the skull base at the time of birth is held by the neck of the uterus, which expands under the effect of contractions. The base of the skull thus receives a surge of labor forces of the uterus so that the cervix is not yet open enough to allow the release. High stress will ensue, especially at the first cervical vertebra (Atlas), the occiput and the sacrum associated with the vertebral column.
During a normal development of the child, the occiput is formed by four parts which are: basilar, both condylar parts and the squama of the occipital.
The occipital condyles are articulated with the first cervical vertebra. The spinal cord goes through the center of the occipital bone (foramen magnum). On the side of the condylar parts there is a foramen; the jugular foramen, through which passes three cranial nerves that are very important:
The glossopharyngeal nerve which controls pharyngeal phonation and swallowing.
The vagus nerve, which controls the cardiac, respiratory and digestive systems.
The spinal nerve which controls a part of the musculature of the neck and shoulders.
These neural structures can be compressed by the deformation of the bone during a traumatic birth or a cranial suture impacted. Other nerves go further ahead to the basilar process, (between the occiput and the sphenoid) may also be affected by a traumatic birth especially the motor nerves of the eye whose achievement can determine the appearance of strabismus.
The jugular foramen also allows the passage of vascular structures where 95% of the venous blood passes at this level. It is important and essential to maintain the quality of the blood flow for the tissues nutrition and particularly the nervous tissues, essential for the psychomotor development of the infant. The structural integrity of the skull’s base is essential to a healthy life and therefore the proper development of the central nervous system.
When the child falls into the pelvis of his mother, he encounters the barrier of the cervix.
The skull of the child seeks for the largest diameter possible to pass more easily, his head down parallel to the anterior pelvis. At this point the skull can be uncomfortable and shaped by the prominence of the sacrum or the pubic of his mother.
The skull driven by the uterine contractions, continues to go down and turns in order to present the posterior face of the cervix (normal birth). The forces applied on the skull are considerable, these forces can mark a mechanical print that will remain visible. These stresses are not necessarily detrimental to the child, if the nature has programmed it, it's not for nothing. However, these constraints can be detrimental if the labor is too long, or if the contractions and the resistance of the tissues of the mother is too important.
Osteopaths have highlighted the importance of modeling the skull of the child for the initiation of head movements. By analyzing the movements of the skull of normal born children and those of children born by Caesarean section, they showed that the movements and range of motion of the skull of a child born by caesarean section were smaller, less extensive, less pronounced and even sometimes poorly defined.
The skull shaped at birth by natural means, shows also malfunctions that may have an impact on the physiology of the body of the child. The normal birth is a birth that occurs without trauma neither for the child nor the mother. Birth is a normal process of life and should not be regarded as an event that automatically causes problems. The excessive medicalization of childbirth often leads to complications that would not be if we let the normal process of childbirth speak spontaneously.
The child has to be not too big to avoid an aggravation of the conflict between his skull and the mother's pelvis.
The mother's pelvis must be balanced without blockage in the sacro-iliac joint. Such a blockage does not allow the pelvis to better adapt to the constraints that it will bear during the childbirth.
The inertia of the tissues is an important element at the time of birth, the tissues of the body are capable of accepting high stresses, but they need time.Inertia can be demonstrated by moving a boat on the water, it needs a small but lasting force to get started, but a quick and intense force would have a very small effect.
The human body shows a great inertia to the movement. Cranial osteopathy is very effective in infants and small children because their skull is malleable. The presence of fontanelles presents an amazing opportunity of modeling. In the presence of deformations of the skull (known in medical jargon as plagiocephaly) we must use this opportunity that the nature gives us to respond as soon as possible during the first days of life.
These constraints will impact on different cranial sutures or restrict the mobility of certain joints which impact upon the function or functions that depend on it. Most often nature does things right, corrections will occur spontaneously, but in some cases, it remains wholly or partially blocked, it can lead to diverse symptoms such as:
Hearing problems, ear infections, fragility ENT.
Visual disturbances, strabismus.
Sleeping problems, nightmares, focus difficulties.
Lack of appetite, regurgitation.
Speech disorders, delayed speech, dyslexia.
Occlusion disorders, etc…
An early osteopathic treatment determines its effectiveness as the progressive ossification of the skull limits the success of the intervention.