CAN BIRTH BE TRAUMATIC?
Birth is a beginning. The cycle of life. Filled with hope. Unfortunately, birth may also be our very first trauma. The trauma of birth may be extreme, and cause obvious injury. However, not all injuries are obvious. Even a “normal” birth places extreme pressures on the infants cranium. And these pressures all too often cause the irritabilities and problems so common in the newborn.
The tiny infant is extremely resilient; able to withstand tremendous pressures as we are squeezed through the birth canal, and take our first breath. Our first breath infuses our tissues with life, and expands our compressed bodies to ready ourselves for the world. The infants head (occiput) plays a significant role in opening the birth canal. The normal pressures of birth cause the cranial bones to fold over one another. The membranes (meninges) and fluid (CSF) surrounding the brain act as a buoyant shock absorber. The nervous system, always attempting to maintain stability under duress, organizes around these forces. These are protective mechanisms that allow for maximum brain capacity and minimal brain trauma.
THE COMPRESSIVE FORCES OF BIRTH
Many of the problems commonly experienced in infancy may be caused by the forces of labor and delivery. If the compressive forces of birth are too great, the nervous system may become overwhelmed, and the skull bones may not be able to fully re-expand to their normal state of ease after the birth. Some births may not appear at all problematic, but can still produce substantial compression. An abnormally quick labor may prove equally overwhelming as one that is long and difficult. The newborn’s baseline physiology may become firmly affected by these compressive forces, producing structural imbalances, physiologic irritabilities, and a variety of symptoms. These symptoms may range from minor variants of “normal” irritabilities to serious pathology. A table of common problems associated with birth trauma is provided below.
- May be necessary to save the life of the newborn.
- May be necessary when the infant becomes stuck in the birth canal for extended periods of time, putting extreme pressures on their little heads.
- May be scheduled, for a variety of reasons.
Many infants born by Cesarean Section first endure a long period of labor, with their heads lodged in the maternal pelvis. The delivering physician also may sometimes place considerable force on child’s cranium, while attempting to free the infant from the pelvic bowl. These infants, though born by Cesarean Section, do experience significant cranial pressure, and suffer the consequences. Some infants born via caesarean section do not encounter any compressive forces. We might think that the lack of trauma in a C-section is the best for the infant. But other factors come into play.
WE NEED TO BE SQUEEZED THROUGH THE BIRTH CANAL
This squeezing initiates a cascade of events that readies us for the outside world:
- Fluid is squeezed out of our lungs.
- Pressure is created for a powerful FIRST BREATH
- Our central nervous system is stimulated and begins to organize.
- Dramatic changes take place in our circulatory system.
Intra-uterine life is very different than life outside the womb. Immediately after birth, the changes in the circulatory system are staggering:
- The umbilical vessels spasm shut. Blood no longer comes from or goes to the placenta.
- A hole in the heart (foramen ovale) closes.
- The lungs will now receive and oxygenate the blood (ductus arteriosum closes).
- The liver will now metabolize the blood (ductus venosum closes).
- The kidneys will now filter the blood.
- The GI tract will now absorbs all nutrients.
These adaptive changes must occur in a systematic and orderly manner, and place huge demands upon the newborn. Should this transition to extra-uterine life be too quick, or disrupted – these changes in the vascular system may be less organized. Osteopathic Physicians perceive this disturbance as a “shock” or irritability that establishes itself in the nervous system of the infant; a potential cause of many problems. Though no apparent trauma may have occurred, the infant may be in pain, or be irritable, or weak, or may be more susceptible to infection.
TREATMENT OF CHILDREN
Osteopathic treatment eases the shock, and restores vitality. By allowing the nervous system to relax and heal, normal maturation may proceed. Not all problems can be resolved, but many can be eased. And for some, Osteopathy is the answer.
Like adults, each infant is constitutionally unique. Some infants seem to tolerate significant trauma from birth, without ill effect. Others are disrupted by even the slightest insults. Each of us is born with our individual sensitivities. We are all affected differently by life.
What kind of results can you expect? Again, every child is different. Some children have a very rapid and complete resolution of their presenting complaints with only a few treatments. Some children need to be treated many times, and recover only partially. Children with developmental delays may not experience immediate change, but it is possible they may begin to mature at a more normal rate of development. The unique circumstance of each child must be considered. The goal is to allow each child to realize their optimal potential.
As a general rule, it is always best to receive treatment as close in time to the traumatic insult as possible. Infants may actually benefit from receiving treatment immediately after birth. The less time the traumatic forces have to establish themselves in the tissues, the easier it is to clear them. Surprisingly, even stresses that have been long imprinted into our nervous systems can still be cleared many years later.
CASE EXAMPLE – INFANTILE COLIC
A long, difficult, but otherwise normal birth produced an apparently healthy newborn boy, with extreme irritability and inconsolable crying. He could not settle easily, sleep well or nurse effectively. The diagnosis was Infantile Colic. The parents were distraught, not only from their inability to help their suffering infant, but also from their lack of sleep. On palpatory examination an “occipital condylar compression” was discovered. After two or three treatments the child calmed. His ability to sleep and nurse improved, and harmony was restored in the home.
Understanding basic anatomy helps explain how Infantile Colic may be caused by excessive pressure to the infant’s Occiput, during birth. The newborn’s Occipital bone (the presenting part in most births) is located in the back of the head.
In the photos below, you can see that at the time of birth, the Occiput is in 4 parts. By the age of seven, these 4 parts fuse to become a single bone. Important cranial nerves lie next to these parts, and the spinal cord passes between these parts, through the foramen magnum (a “large hole”).
Adult Occiput Fetal Occiput
1 piece 4 pieces
During birth, the infants head must flex, rotate and extend, as it passes through the bony pelvis. As the “presenting part,” this unfused occiput receives a complex array of forces. The 4 parts of the occiput may become twisted and compressed, causing irritation of the nestled cranial nerves, and sometimes even irritating the spinal cord. Impaired sucking, gastric irritability, and altered muscular tone may result.
Osteopathic Treatment involves carefully placing the clinician’s hands upon the posterior occiput of these distressed infants, encouraging the occiput to decompress and untwist. Obviously, the forces of birth do not stay localized only to the Occiput. We naturally evaluate and treat the entire infant, with the intention of establishing fluid continuity throughout.
COMMON PROBLEMS ASSOCIATED WITH BIRTH TRAUMA
||Chronic Upper Respiratory Infections
||Chronic Ear Infections
|Spitting Up / Reflux
||Chronic Nose Bleeds
||Recurrent Urinary Tract Infections
|Abnormal Muscle Tone