The baby's birth experience - an osteopathic perspective

Treating babies over the 19 years since I qualified I’ve heard many, many birth stories, and met many mother and baby pairs struggling with post birth adaptation, including feeding and settling.

When we take an osteopathic case history, we are listening for lots of clues about why the presenting problem has arisen and what might be maintaining it. In particular, when I listen to a birth history, I’m thinking – so what was the baby’s experience in all of this? And how might that be impacting the reason they have been brought in for treatment?

Sometimes it may be clear; other times less so. There can be an ostensibly straightforward delivery with a very unhappy baby; other times the baby seems to be doing amazingly well given a long and complex delivery. It can be quite a mystery.

In particular - being born by elective Caesarean section may seem to be the easiest possible delivery, and of course there are compelling clinical reasons for it, but some of these babies are particularly unsettled and proportionally more of them need feeding support. Why might that be?

The answer might be something to do with the speed at which it all happens. In a vaginal birth, the baby is “primed” for the forthcoming transition by the uterine contractions and squeezing through the birth canal, which seems to help them make the transition. The squeezing also helps the lungs spring open as the baby takes its first gasps of air.

Contrast this with a caesarean – the baby might have been asleep and suddenly they are pulled into a brightly lit and noisy environment. They have less squeezing and less preparation for what’s about to happen. Some of them remain very unsettled for a while afterwards as their immature systems cannot regulate well in the early days. They may be “Velcro” babies and difficult to put down and the tensions they retain affect feeding mechanics and digestion. All this also points to what is known as low vagal tone, when the vagus nerve, our body’s key regulating neural circuitry, is not firing efficiently to help soothe and calm the system as a whole.

Many babies with feeding and settling issues are showing us that they are struggling with synchronisation of their bodily rhythms – suck, swallow, breathe, rest and digest. The osteopathic approach is to listen to their systems in such a way that they can settle and recalibrate to a steadier rhythm that helps their physiology function  more efficiently.  A first visit might be entirely about this “re-setting” so that the foundations are there for healthy and rhythmic bodily function. The body’s amazing innate intelligence knows what to do if the foundations are in place.

Of course there may be more specific anatomical restrictions that need attention and we work gently to help these resolve too. It need not take long to turn things around and get the situation much more settled and enjoyable for mother and baby. It’s lovely work to do and I’m always pleased to see another pair off to a good start in this amazing new phase of family life.

You are welcome to book in for a chat if you would like to understand a little more about how osteopathy might help you or your baby with post birth adaptation. See my appointments page. I look forward to meeting you 

Keeping moving through back pain – why?

Until quite recently, medical advice for low back pain was rest and painkillers. But clinical trials have shown that keeping moving, even if it’s painful, creates much better outcomes for back pain sufferers.

Why would that be?

Well to begin with, bed rest weakens us really quickly. Studies show a 12% decline in muscle strength per week (see note 1) and commensurate loss of muscle mass. Which means that if we stop moving, it makes it even harder to get going again. And weakening tummy muscles in particular will mean that we have even less support for our back than we previously had before the back pain kicked in. This is part of what is known as ‘core stability’ and very important for both our overall stability and even the health of our inner organs. Ligaments and tendons around our joints, and even the nerves that supply all these tissues can be negatively affected too.

Secondly, our bone health and density is linked to use, and weight-bearing exercise. Walking counts here. Every step we take stimulates the cells in our bones to keep metabolising bone to keep us strong and keep the calcium in our bones. When we rest our cells also respond – by taking calcium out of bone to use for other things, which can ultimately predispose us to kidney stones. This applies to all bones in the body, not just legs, pelvis and lower back. They all need movement to stimulate bone health and strength. So resting weakens bone.

Beyond these two major effects, bed rest is known to negatively affect us in almost every way, involving our hormones, sense of well-being, lung and heart health, immune system function, and more besides.

But rather than dwell on the downsides of rest, perhaps we should think about the benefits of movement? During our osteopathic training we were shown time and again that movement and health are almost equivalent for our bodies, both as a whole and in part. NICE guidelines (see note 2) now minimise use of ‘RICE’ (Rest, Ice, Compression, Elevation) for ankle sprains because again it has been shown that tissues repair better when they are moved – it helps strength and blood flow which brings healing faster.

Lastly, all movement and exercise help the body as a whole. All our joints are supported by all our bones, muscles and other joints. Think of the body as being held together by inner elastic (fascia) which is always in reciprocal tension so that as one bit of us moves, all of our body adjusts to the movement. This is a principle known as Tensegrity (see note 3), and it helps us counteract gravity. So the joints in our lower backs need the joints in our pelvis and shoulders to be working well to help them stay healthy and not get compressed by our own weight . Exercise like pilates and yoga help the whole system function well together, and reinforce healthy movement patterns.

So even if you are feeling a bit crocked, try and keep going, you’ll feel better for it and recover more quickly. Let us know if you need a bit of help to speed your recovery!

Julia

Notes and links

1. Effects of bedrest 5: the muscles, joints and mobility

2. Sprains and strains

3. Tensegrity

Photo

Nomadic Julien on Unsplash

Treating Newborn Babies

It’s a particular treat and privilege to be asked to treat newborn babies. Their “newness” is beautiful in itself, possibly because in that moment they show most clearly the miracle of how we all come into being.

The first 3 months of life after birth is a major period of adjustment for the whole family. For the baby this is as much internal as external adjustment, because they now have to breathe air and digest food for the first time. The heart fully takes over the internal circulation from the placenta, and the lungs decompress, drain fluid and begin to oxygenate air for metabolic use. They will keep growing in surface area terms (alveoli) relative to total body size, for the next three years. Meantime the digestive tract has to accommodate milk rather than meconium and cope with air (wind) as well as milk. On top of this the newborn is encountering bright light, clothing, and a new relationship with gravity and noise. Not to mention parents and siblings!

If the delivery has been fairly straightforward, both baby and mum get a headstart in getting on with each other and getting used to everything else. If not, however, this is also a moment where mum can be in recovery as much as her baby and both need some careful attention as they adjust to this new phase of life. I try to gently suggest to mums to be to have some time before the birth – ideally around a month – to prepare themselves for this life changing event, because there is often limited opportunity afterwards. It’s hard to see mums still trying to recover from their own experience, and perhaps understand what happened, while caring for their newborn and getting limited sleep. The postpartum period is known for its hormonal ups and downs, and lack of sleep never helps! Recovery takes energy and it can be helpful to have reserves to draw on.

I’m always pleased to meet partners too; they often come to the first appointment and sometimes they have also asked for treatment after the delivery. It’s common to feel quite fragile after supporting long demanding labours, especially those ending with interventions. The lack of control is stressful in itself, and more so where progress is not straightforward. Partners are invaluable for helping to create the supportive and nurturing environment mum and baby need most especially in the early days post-delivery. This is an important moment for the family unit and lays the foundations for the coming months and years.

At the Osteopathic Centre for Children I have learned to consider the whole family dynamic while treating; we routinely offer treatment to new mothers because we believe (like most birth professionals) that the baby will do well if mum is doing well. Mum will do well with her partner and family’s support. Giving birth is an emotional and spiritual event as well as physical one. And it is indeed a privilege to be invited to help at this precious moment in life.

I Treat Rugby Players as Well as Babies!

There’s nothing I like more than a “knotty problem”. Something that’s been there for while, won’t go away, keeps coming back to bother it’s poor “owner”, perhaps to the point that it’s stopping them from doing what they really want to do.

Let’s take James (name changed for privacy reasons) who recently came to me with a problem in his right arm and shoulder after a rugby injury 8 months ago. Someone kneed him forcibly in the armpit in a ruck and since then he had lost a lot of power in his right arm, could no longer do chin ups (he used to be able to do 4 lots of 8 ) and was getting a lot of tingling into his fingers and felt his grip has less power than it used to have. He was quite distressed at the prospect of having to give up his rugby career in his mid twenties. He had had some treatment from the club physiotherapist but no real change in his symptom pattern.

In osteopathy we are trained to reason back to cause, so my job was work out what was stopping him getting better and help his body to find its way back to normal. We looked at how his shoulder blade now seemed to be very stuck onto his back and inhibiting the movement in his shoulder; how the muscle balance in his arm was disrupted and the bone out of position; how the his ribcage was a different shape on the right and the left; and that he was still carrying the trauma from the injury in his tissues.

Osteopathy allows us to allow bodies to rebalance themselves by helping to release shock, support the bones back into better alignment, and improve blood supply to the tissues , which helps healing. I used some soft tissue massage, some articulation of his shoulder, and some cranial technique to release the shock and help the bones align. After 2 treatments James could manage 4 chin ups again, his grip had improved and the tingling had subsided in his hand. He was able to do press ups and felt a lot better. Now he is looking at getting his training going over the summer to get ready for the new rugby season in the Autumn.

If you would like to talk to me about how osteopathy might help you, please get in touch on 020 7993 8116 ; I’ll look forward to hearing from you.

Beware Dishwashers! A Guide to Managing Low Back Disc Pain…

If you’ve ever had the misfortune to injure a spinal disc, you’ll know what an unpleasant and acute pain it gives and how unrelenting it can be in the early stages. People say the pain is 8,9 or 10/10 in terms of how bad it is. Ouch! And if you are unlucky, you may also have shooting (or even constant pain) into your limb, or numbness in a hand or foot. It can make you feel very vulnerable and is very distressing.

The best advice for nearly all low back problems, including discs is:

Keep moving – do whatever you can, 5 minutes an hour at least, walking is great. Movement helps get fresh blood to the problem area and this brings healing. Keeping still for too long weakens muscles and allows tissues to congest.

Ice it – 5 minutes at a time. Use an ice pack or plastic bag of ice in a damp tea towel, on/off. Especially before bed if you know it might be bad in the morning.
Avoid sitting for too long. Stand or lie down flat; if you have to sit, choose a supportive upright chair and stand up regularly and walk a little to relieve your low back. Avoid slumpy sofas! They are just about the worst thing you can sit on, and might even have helped cause the problem in the first place.

Sometimes lying on your tummy and pushing up into a “sphinx” position can give relief – see if it might help you?

Drink plenty of water – the centre of the disc is like a jelly that sucks in fluid. It expands overnight as we rest and compresses during the day with the help of gravity. Water helps “plump up” the disc and make it more robust. It also helps you clear inflammation from your system. Did dehydration contribute to why this happened?

Painkillers – can be helpful BUT they are now known to interrupt the early stages of healing by suppressing the inflammatory process (which is a necessary part of healing); so use judiciously and be mindful that they can upset your stomach lining (ibuprofen ) and give your liver a lot of extra detoxification work to do on top of the work it is doing to manage the healing crisis.

Beware dishwashers! Being bent over and twisting is just about the worst possible thing you can do so be very careful about how you use it. A good opportunity to enlist some help with the chores…

Without wanting to preach – have a think about why this happened. So often it can be your body’s way of saying “I’ve had enough, stop it”. It makes you stop, to give you a chance to get to grips with a situation. The body keeps the score…

And finally…trust your amazing body to fix itself too. You’ve doubtless got better from any number of coughs, colds, cuts and bruises, and you will recover from this too. The job in hand is to help your body on its way by being kind to yourself and creating the right conditions for it to heal.

If you've been putting up with pain, simply give me a call on 020 7993 8116 and find out if Osteopathy could help your problem.

Preparing to Labour Well: Top Tips

Get nesting

Stop work about a month before your due date if you possibly can. You simply don’t need deadline stress and other people imposing their priorities on you when you are about to undergo a life changing event!

Having more time and the mental and physical space to settle into your own body, and tune into the baby, is invaluable.

You could also stock the freezer, bank up some sleep, and find out about local post birth groups so you know where to go if you need support afterwards. And get a haircut…

Get comfortable

Explore what helps you relax best. Likely a combination of both gentle, regular physical activity, and rest. This will set you up to labour well.

Gentle regular activity will tune you in to how you feel physically, which is a good place to prepare for a birth from.

Resting while lying on your left side can help ease fatigue and aches and pains. You can pump your feet up and down in this position to ease any swelling, and monitor your breathing here too.

Being relaxed will allow your body to adjust to the growing baby by allowing your bones, muscles and ligaments to respond to your internal hormonal state.

Learn to breathe well

Hypnobirthing is a well known and trusted method of preparing for labouring. How we breathe can profoundly affect how well we feel. It can affect how much energy we have and our sense of control in difficult situations. It can even help digestion, reflux and ankle swelling.

Good breathing should synchronise the pelvic floor and diaphragm, helping to return fluid from the legs back into circulation. It also gently oscillates the ligaments that support the uterus and helps sphincter function. Your osteopath will be able to help you with this, or check out local hypnobirthing teachers and online courses. An experienced practitioner can tell you how well they think you are breathing, and how it can be improved.

Good positions to practice breathing in are lying on your left side; kneeling with knees wide, or supporting arms and tipped forward eg onto the end of a bed or table.

Mindset

There are many ways of understanding your own mindset better. You could try mindfulness? The main thing is to develop some self awareness about how you are feeling in your body, and to become more aware of the baby as well. You can do this by sitting or lying quietly, observing your breathing and checking in with how each bit of your body feels, and even talking to your baby.

When they are born they already know your voice…

Trust

Giving birth requires trusting both your body and the professional help around you. It is neither a matter of will power and determination, nor surrendering responsibility to someone else. We have been doing this for millennia, and we can all labour well in the right conditions, our bodies know what to do. Aim to strike a balance between what you can do for yourself, and what you need help with. It is helpful to know what to expect, but not helpful to feel frightened of it.

If you find that you are fearful, talk it through with someone you trust, till you can feel more trusting of your body, the support you have in place, and the process itself. Come the moment there is a need to simply accept what is happening, and allow it to happen. An extraordinary experience to be had, a miracle unfolding.

Breathing Changes during Pregnancy

I’ve seen a number of patients recently who are being challenged to breathe better by their pregnancies. The hormonal changes of pregnancy affect breathing rate and lung resistance, while the physical changes of pregnancy (as the uterus rises up in the abdomen) also affect lung capacity and the angle of the lower ribs.

It is well know that good breathing can improve our sense of wellbeing and calm anxiety and stress. This is because if we oxygenate our system well, we balance blood gases and this in turn can calm the “fear/fight/flight” side of our unconscious (sympathetic) nervous system. The first step towards doing this for ourselves is often to breathe out slowly and steadily, and thereby make it easier for us to take on oxygen efficiently in the next in-breath. So good breathing starts with good exhaling; it’s much more relaxing than breathing in – try it!

Many pregnant women find they are short of breath, typically in the first and third trimesters. In the first trimester, rising progesterone levels dilate the smooth muscle of the lungs to facilitate better elimination of carbon dioxide, but the increased metabolic demand of the growing fetus may still outpace this effect. So it is quite common to find women breathing more rapidly in early pregnancy to accommodate this.

In the third trimester, the growing baby tends to push the abdominal organs up against the diaphragm, which often rises up to 4cm to accommodate this growth. To compensate, usually the lower ribs flare to increase lower lung capacity and meet the body’s oxygen demands. But I have seen a number of women who have habitual tension in these lower ribs and struggle to make this change. It can even be quite painful as the tissues are resisting quite significant internal forces. This stage of pregnancy often brings reflux for similar reasons; here the diaphragm may not be accommodating change well and not closing off the upper sphincter of the stomach effectively. Any reflux sufferer knows how unpleasant this can be.

Rather than leaving it till late in pregnancy to engage with breathing patterns, it’s well worth trying to optimise breathing early on as it can have a profound effect on your wellbeing and even your sense of personal space. Feeling crowded by work pressures when you are tired and taxed by a growing baby is no fun. Learning to breathe well can make quite a difference to how you feel, it can help create a sense of space and ease that will stand you in good stead throughout the pregnancy and prepare you to labour and nurse well too.

Many of us constrain our breathing and sustain quite high levels of tension through all the layers of tissue in our rib cages, from the outer muscles and ribs even to the lungs themselves. You can assess your own breathing and tension by just watching your breath quietly and noticing how you feel as your inhale and exhale. What is easy and what feels strained? Once you’ve done this for a minute or two, then try exhaling for a little longer and allowing your in-breath to follow gently into the space you have created. Notice how your diaphragm expands and contracts, drops and rises. Quite mesmerising if you get absorbed by the rhythm of it! And a useful way of connecting with yourself, which is beneficial for all of us sometimes. And some of us most of the time!

Here’s a great summary of the science behind breathing changes in pregnancy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818213/

Do please get in touch if you would like some more help with anything I have discussed here – 020 7993 8116 or julia@juliafinlayosteopath.co.uk

How Good Breathing Underpins Good Health

My top 10 benefits of breathing well

• You will feel more relaxed … a good start.

• You will have more energy from more oxygen in your system

• Your adrenalin levels drop as your blood oxygen increases – calm AND relaxed!

• Digestion improves as the gut organs are massaged by the diaphragm

• Digestion also improves because you digest better (in terms of hormone secretion and absorption of nutrients) if you are more relaxed

• Your immune system can work more efficiently as lymphatic fluid is moved around the body by full movement of the diaphragm and white blood cells can get around to where they are needed more easily

• Elimination of digestive waste is helped along by the diaphragm

• You might find you have a clearer head from better oxygen levels and better fluid movement in the body (veins and lymphatics) and elimination of waste

• You may feel like you have more time

• You may find it easier to make decisions…or make better decisions… or do less but feel like you’ve got more done…..and....you may simply feel better.

So what does good breathing look like?

If you look at a baby or young child, chances are that you will see their belly moving as they breathe. This is a good thing! It is a sign that they are using their diaphragm well when they breathe, and that this is massaging all their abdominal organs as it moves. This in turn helps their digestion and elimination of waste, because it helps move it all through the gut.

It also means that they are using the lower part of their lungs to breathe from, and this means that they will be taking up oxygen and eliminating carbon dioxide more efficiently than we do from our upper lungs. This is due to air pressure gradients and how they influence the take up and release of our blood gases – it is most efficient (easy) in our lower lungs just above the diaphragm.

How to breathe well:

• I suggest you try and do this exercise morning and evening. In the morning perhaps best to get up first and do before/after breakfast; in the evening this is a good way to relax before going to sleep.

• Begin either sitting or lying down; relax (drop) your shoulders and make sure you are straight without being tense.

• Put a hand on your belly button and begin to push your hand out with your tummy as you breathe in through your nose for a slow count of four. Direct your breath to the space you have created in your abdomen.

• Pause briefly

• Begin breathing out through your mouth for a slow count of seven. As you do so, follow your belly back towards your spine with your hand. If you feel any tensions (e.g. in your shoulders and neck) try to let them dissolve away as you breathe out.

• Pause briefly and repeat 9 more times, or more once you’ve got the hang of this.

When you first try this you may find it quite difficult and feel as if there’s an “argument” going on in your body about what to do. If so, perhaps try breathing out first, and then try breathing in – you may find that it helps you relax into it better.

If you would like to see if osteopathy can help you, give me a call on 020 7993 8116 and I’ll be delighted to talk to you.

Wonky Babies

Lots of parents bring their babies to me saying “ they only look one way”! Which is a strange thing in a baby, when we usually think of them as perfect.

It’s actually quite common for a baby to have a stiff neck so that they only seem to be comfortable looking one way. Sometimes if you look at them as they lie on their backs, you might see that their pelvis seems to be going the other way; either that or they seem curved around in a banana shape.

The good news is that gentle cranial osteopathy can help stiff baby necks and backs and get them back to better symmetry. It can help normalise body patterns, and release any associated muscle tension and strain. This might even help any digestive difficulties s/he is having along the way, as they may resolve once your baby’s body is back in better balance.

If you would like to talk to me about how osteopathy might help your baby, please get in touch – 020 7993 8116 or julia@juliafinlayosteopath.co.uk

Osteopathy and Health

Of the people I saw this morning, two had waited a couple of weeks before coming to see me. That’s very normal – we are all used to having occasional aches and pains and a lot of them just go away on their own after a few days. Those that don’t clear up on their own are the ones that people bring in with them. And the question here is “why not”? almost more than “why do they happen in the first place?”

As osteopaths our philosophy is to “find the health”. (Andrew T aylor Still, who discovered osteopathy, went on to say “anyone can find disease”…). What he meant was that it’s usually pretty easy to see what’s wrong, and perhaps give it a name. The challenge is how to help the body resolve the problem. Our role as osteopaths is to help the body do this using its intrinsic resources.

Part of “finding health” is to look at the problem in the round. How long has it been there, what brought it on, is it getting better or worse, what makes it better or worse… and more besides. Beyond this we can look at whether a person is happy in their life, what strains and stresses they are under, and what can be done about them. One of the joys of having an hour with each person or parent and child is being able to spend some time discussing possible contributing factors, and working out what changes might be beneficial. It sometimes takes a minor crisis to wake us up to bad lifestyle habits we have developed like going to bed too late or drinking too much coffee.

Recently I spent a weekend on a course with fellow osteopaths looking at how to support health in a patient’s system itself. Here we get a bit more esoteric – is health a substance?? Well not exactly, but…you might not surprised if I said that stress is a factor in a lot of patient presentations and that stress is a physiological phenomenon. Symptoms of stress in adults, babies and children alike include digestive problems, inability to relax and sleep, and headaches . We have receptors for hormones on each cell of our body , so we really do feel our emotions in our whole body - see www.cadacepert.com and below. A stressed body cannot repair easily or well – it finds it difficult to connect with its health, as if the stress gets in the way. So my job is to help the system “de-stress” by using calming techniques to facilitate more ease, and then support the health that is present despite the presenting problem . We always have health in reserve, it’s what keeps us going!

So to help healing we need to focus on supporting health? I would say so, yes . After 19 years in practice my reverence for the inner wisdom of each body is ever increasing. We are all individuals and our individuality is expressed through the healing journeys we make, both internally and externally. “ Life is always trying to express health” .** My job is to help get them to the place from which they can heal themselves.

Candice Pert, Molecules of Emotion; Why you feel the way you feel. New York Scribner 1997

** Rollin Becker, p11 Life in Motion . Stillness Press LLC, Portland. Oregon 2006