Osteopathy in pregnancy, babies treatment and post-natal care

PREGNANCY

Pregnancy is a wonderful physical experience. A unique event for a mother’s body. Enormous physical, chemical and emotional changes take place over a relatively short period of time. The baby literally takes over, and the whole body of the mother has to adapt to carrying the baby, which can impose physical strain on all the organs and tissues around it.

As the uterus grows, the mother’s body has to cope with the extra weight and also to accommodate the increased size and shape of the womb, creating postural adaptation. These are made through the production of a natural hormone called relaxin that increases during pregnancy. Its main job is to soften and loosen the body’s ligaments and tissues so the pelvis can expand and prepare for birth.

Osteopathy

Osteopathic manual treatment is beneficial in releasing longstanding physical strains and stresses from the body, as well as relieving physical discomfort.

The discomforts of pregnancy:

Nausea and vomiting:

During the first 12-16 weeks, it is common for women to suffer nausea and vomiting and feel excessively tired. Osteopathy can sometimes be of help in restoring a sense of well-being by relieving debilitating physical strains and restoring musculoskeletal harmony and balance. The treatment to improve the circulation to and from the liver can help with nausea.

Heartburn:

During pregnancy, the lower ribs and broad muscular sheet of the diaphragm gradually spread to increase the size of the abdominal cavity. This can place strain of the sphincter at the top of the stomach, which is formed by a loop of muscle from the diaphragm curling around the lower end of the oesophagus. This sphincter normally keeps all. The stomach contents are tightly inside, but if stretched or distorted, it may allow small amounts of its acidic contents to leak back up into the oesophagus. This causes the classic burning sensation of heartburn.

Osteopathic treatment can often help to alleviate heartburn by relaxing tension in the diaphragm, thus helping it to change shape without any undue stretch on any part, so helping the sphincter to function better. 

Breathing difficulties:

The increasing size of the abdomen and the resulting change of shape of the lower ribs and diaphragm that has been described reduce the available volume of the lungs. This may cause some breathlessness, particularly when lying down.

Osteopathic treatment can improve function of the whole rib cage and enable full use of its available capacity. This also helps the lymphatic system to function efficiently, which in turn assists the immune system of the body.

Aches and pain:

If the mother had a back problem before becoming pregnant, or has suffered significant trauma to her back, neck, head or pelvis at any time in her life, then it may be very difficult to her body to make the necessary healing process. As the spine struggles within its pre-excising limitations to accommodate the size and weight of the uterus, undue strain can be placed on all or part of the spine. As a result, the muscles have to work harder to support the spine so that more energy is used for everyday activities. This may cause symptoms as diverse as back or neck ache or pain, numbness or ‘pins and needles’ in the arms or legs due to nerve irritation, fluid retention, headaches or undue fatigue.

An osteopath can identify regions of the spine that may be moving too much and are thus vulnerable to over-strain, or areas that are stiff due to yield to allow the posture to gradually adapt the changing size and weight of the uterus. Treatment to harmonise the mobility throughout the spine allows the spine to find a balanced position and shape that can be maintained with a minimum of muscle tension.

Osteopathic treatment can help release tension in the muscles of the pelvis and the ligaments supporting the uterus, and balance the relationship between the main pelvic bones and sacrum or tailbone. This relieves any strain in the joints and soft tissues of the pelvis and improves the general circulation within the pelvis and lower limbs.

Pubic symphysis pain:

The pubic symphysis is the tough ligamentous junction at the front of the pelvis that joins the two halves of the pelvis together. Pain is often felt in this area during late pregnancy. The pain is caused partially by the normal softening of ligaments in pregnancy and partially by the pressure of the baby’s head inside the pelvis. The pain can be quite intense and may limit the amount of walking possible in the later stages of pregnancy.

Osteopathic treatment may be of some help at this time, as may be wearing a maternity corset to help support the pelvis and weight of the uterus.

Preparation for labour:

An important part of preparation for childbirth is to ensure that the mother’s pelvis is structurally balanced and able to allow the passage of the baby down the birth canal. Trauma to the pelvic bones, coccyx or sacrum at any time in a mother’s life can leave increased tension in muscles and strain within ligaments and bones of the pelvis. This can limit the ability of the bones to separate and move out of the way during labour, and thus limit the size of the pelvic outlet.

Osteopathic treatment is extremely effective at releasing old strains within the pelvis, thus giving the best chance of an easy and uncomplicated labour.

BABIES

It’s a common belief that children and babies should have no structural stresses and strains in their bodies, because they are so young and flexible. The reality is different. The birth of a baby is one of the most stressful events of their life. To baby is subjected to enormous forces as the womb pushes to expel the baby through the birth canal. The baby has to turn and twist as it squeezes through the bony pelvis, on its short but highly stimulating and potentially stressful journey into the outside world.

The baby’s head has the ability to mould and change shape in response to the stresses of a normal labour. The distortions in the head as a result of labour are usually released naturally afterwards. However, there are many reasons why labour may be difficult and stressful for both mother and baby, as a result of which the baby may be unable to fully resolve the effects of birth. If birth stresses remain unresolved, then the baby has to adapt to and accommodate these stresses and strains as he/she grows. This may cause the baby to be either physically uncomfortable and therefore unhappy, or to develop in an asymmetrical way.

If the baby’s body becomes twisted or severely strained at birth, then the whole body will grow in a distorted way and every structure of the body will be required to cope with this distortion.

An example of a common harmless distortion is positional plagiocephaly, or often called flat head syndrome, where a baby develops a flat spot on the back or side of their head. This occurs because a baby’s skull is still soft and flexible in the first months of life, and pressure on one area over time can gently change its shape. Often one cause is the use of instrumental delivery, such as forceps or vacuum, that applies external forces to the baby’s head for the extraction from the pelvis.

Unresolved birth stress and the body’s adaptations to them are the root of many different problems both in childhood and right into adult life. These stresses can usually be treated very quickly after birth, but become more difficult to eliminate the longer they have been present.

Osteopathy

Following a careful diagnosis, a variety of manual techniques and approaches are used to release areas of mechanical stress. Many of these techniques are extremely gentle and rarely painful.

Cranial osteopathy:

Is a very subtle and gentle approach to the treatment of the whole body (not just the head, as is implied from the name). Cranial osteopathy is a gentle nature approach to treat babies and children.

Newborns issues:

Feeding:

Many babies feed quickly and easily either from the breast or bottle, some babies are very slow and maybe feeds more easily on one side than the other. This may be a sign that he/she has some residual strain in the neck from labour and delivery or position adaptations after born, and can turn more easily to one side than the other.

The nerve to the tongue that controls the sucking action exists from the skull in an area behind the ear. This is the area that takes the maximum compression during the passage down the birth canal. The nerve may be irritated, and this can affect the function of the tongue muscles, making sucking difficult and tiring.

Other factors that can make sucking difficult are:

Ankyloglossia, also called tongue-tie, where the lingual frenulum (the small band of tissue under the tongue) is short, tight, or thick, and limits the movement of the tongue;

• Lip tie or buccal ties;

• High or narrow palate can reduce the tongue contact and the suction efficiency;

• Irritation of the throat caused by the umbilical cord being tightly wrapped around the neck or caused by a face or brow presentation;

• Jaw asymmetry or a small lower jaw;

• Facial or cranial asymmetry;

• Neurological conditions;

• Airway restrictions.

A baby that is finding feeding difficult may be slow to gain weight and makes parents more concerned.

Osteopathy with gentle cranial osteopathy techniques around the baby’s head and structural myofascial release and intra-oral approaches can release the restrictions affecting the tongue mobility, improving the sucking and latching for a better feeding.

Infantile colic:

Colic is one of the major reasons why a baby may cry incessantly and is common in 1/3 of newborns. Often is often caused by intolerance to lactose or cow milk; in fact, the crying is often noticeable a couple of minutes/hours after feeding.

Other causes are immature gastrointestinal function, feeding issues and gut-bacteria imbalance.

Osteopathic manual treatment is effective in reducing the symptoms of infantile colic. There is no single technique more functional, and an osteopath treats all areas where dysfunction is found. A common area where dysfunction is found in babies with colic is in the base of the skull behind the ear. The nerve to the stomach exists from the skull in this region, and this area is particularly vulnerable to compression during normal birth. Retained compression here can irritate the nerve, impair the efficiency of digestion and interfere with normal digestion in the stomach.

The diaphragm, also, can be affected by stress through the trunk of the baby from its passage through the birth canal, from shock from the birth, or a poor first breath. Any impairment in the function of the diaphragm has a major effect on the ability of the stomach to retain and digest its contents.

If the umbilical cord has been subjected to tension during delivery, perhaps because it was wrapped around the baby’s neck, this can disturb the function of the diaphragm. Problems in this area will manifest frequently as windy or colicky babies.

A baby who has been subject to stress in pregnancy via his/her mother will have a more reactive nervous system, and this is thought to contribute to the increased vulnerability to colic in these infants. Osteopathic manual treatment is effective at generally relaxing the baby, which reduces the reactivity of the whole nervous system, including the nerve supply of the stomach and intestines. This often reduces colicky symptoms of discomfort and crying.

Sleep disturbances:

The close link between sleeping and feeding patterns can be found with the inadequate milk intake during the feeding, making the baby to wake sooner for the next feeding. This can easily develop into a ‘snacking and napping’ habit.

There are other things that can interfere with the sleeping patterns of babies. Discomfort in the head may prevent the baby from falling into a really deep sleep, so shutting out everything in the outside world. In addition, the stresses of retained compression on the bony casing of the skull may be transmitted via the coverings of the brain (the meninges) to the brain itself. As a result, the baby’s nervous system may be kept in a persistently alert state. These babies sleep for only short periods at a time, and never seem to fall into a deep sleep. Later in the first year, they are awakened by the slightest noise.

These sleeping patterns gradually become habit forming. If the baby is treated to release the retained birth compression when young, then this alone may be sufficient to solve the sleeping problem.

Sleep patterns may be disturbed by teething, infections, and as a result of accidents. The effects of falls, such as bangs to the head, can disturb the body mechanics in a similar way to the trauma of birth, and cause discomfort in the head, or simply stress that keep the nervous system in an aroused state, which prevents the child from sleeping soundly. It is common for a child to succumb to an infection after a traumatic fall, because the immune system is temporarily disarmed by the shock of the fall.

Osteopathic treatment can be effective at releasing the physical effects of teething or accidents, and allows the child to settle back into a normal sleep pattern.

POST-NATAL CARE

With the excitement and exhaustion of the first few days and weeks with a new baby, parents are usually focused wholly on meeting the baby’s needs. It is easy to forget that the mother’s body is going through some major changes as it recovers from both the pregnancy and the birth.

The care and nurturing of a young family is an unrelenting 24 hours a day, 365 days a year job. The demands continue no matter how the mother is feeling, so she has a responsibility to take good care of her own health in order to be able to meet these demands.

Osteopathy:

Osteopathic manual treatment has a very important place in helping a new mother to recover physically and mentally from the pregnancy to the labour and afterwards.

Common problems that osteopaths encounter in mothers after childbirth:

- Pelvic strain during childbirth due to:

• Pre-excising strains within the pelvis that limit its ability to spread to allow the passage of the baby

• Asymmetrical positions of the mother during labour

• Prolongated, too fast or difficult labour

• Large baby

• Baby’s position and presentation, such as breech or shoulder dystocia

• Instrumental delivery, such as forceps or vacuum extraction

• Diastasis rectus abdominis

-Scar-related restrictions, from caesarean section, episiotomy, or perineal tears

Feeding:

In the early days, much time is spent feeding the baby, and it’s important for the mother to sit in a well-supported and comfortable position. When nursing a baby for a length of time, it’s easy to remain stuck in an awkward position, not wanting to move for fear of disturbing the baby. It’s surprising how heavy even a very tiny baby can become after being held for a period of time. Sitting with the head bent forward looking at the baby can cause back or neck ache. Any feeding position can be made more awkward if the mother finds sitting uncomfortable due to soreness from the delivery or from stitches. It's important to find a good position for both mum and baby.

Mastitis is a common problem with breastfeeding. This arises initially due to a blocked milk duct that becomes inflamed and ultimately infected, needing antibiotics.

Osteopathic treatment can be effective in speeding up the recovery from mastitis. Treatment is aimed at improving lymphatic drainage from the breast and ensuring that the rib cage is freely mobile with no areas of restriction.

Return of the uterus to normal:

In the first few days, it is common for the mother to experience ‘after-pains’, which are due to the uterus contracting back to its normal size. The uterus is suspended in its normal position in the pelvis by ligaments that attach to the walls of the pelvis and sacrum. These ligaments can become overstrained during pregnancy, by the forces of uterine contraction, or as a result of pelvic strain after childbirth.

The pelvic floor muscles are important in supporting the uterus and bladder in the correct position within the pelvis. The pelvic floor muscles are weakened during pregnancy and overstretched by the delivery. It is therefore vital to regain good pelvic floor muscles tone after childbirth, and pelvic floor exercises should be done frequently after childbirth.

With an extended post-graduate training in Pelvic Health, Osteopath Giulia Buczkowsky is trained to educate new mums on the pelvic health, doing an internal assessment and treatment with the combination of appropriate pelvic floor exercises.

Postural changes after childbirth:

After childbirth, the body undergoes a rapid postural change to adapt to the traumatic reduction in size and weight of the uterus ad contents. The posture should gradually return to normal in the first few weeks as muscles regain their normal tone, and ligaments shorten to their normal pre-pregnant length.

Osteopathic manual treatment can support new mum to correct wrong adaptation and speed up the recovery process for a better posture pain-free.

References:

• Bo, K., Berghams, B., Morkved, S., Van Kampen, M. (2014), Evidence-Based Physical Therapy for the Pelvic Floor: Bridging Science and Clinical Practice, Elsevier Science.

• Hayden E. C. (2000), ‘Osteopathy for children, third edition’.

• Moeckel, E. and Mitha, N. (2008) ‘Textbook of paediatric osteopathy’, Elsevier Science.