Why Wait Until Second Stage?

image38This article was previously published in the Summer 2011 issue of Midwifery Today.

When mothers receive hands-on treatments like Craniosacral Therapy (CST) and Visceral Manipulation (VM) before and during pregnancy they can help their babies assume ideal positions for birth. Babies who are ideally positioned are more likely to come on time. They often take less time to get born and they function better after they are born.

The Baby Who Can’t Descend
As a midwife, I have long known that babies who won’t descend into their mother’s pelvises during labor have big problems. They can’t get born – vaginally. Midwives have been championing optimal fetal positioning for years. We advise moms about postural and movement techniques to help ensure good birth positioning. However, there is more to it than telling moms to not spend endless hours in a recliner. The moms also need therapeutic bodywork.

If the ligaments that support the uterus are restricted or immobile the babies may never descend into the pelvis the ideal way (head first with chin tucked and facing the mother’s back). They may come down feet first, butt first or shoulder first. If the babies in these restricted-space environments do manage to come head first they may be facing front (occiput posterior) or with chin lifted/neck deflexed (military presentation). They may have their heads laterally flexed (asynclytic), rotated or in some combination of “wonky” head positions. These are not good positions for birth. These are often the “overdue” babies.

Our bodies have wisdom about not starting or progressing labor if our babies aren’t well-positioned for the birth. If labor does begin (or is induced) it may stall because the baby can’t get into the right position. Of course, these babies are often the ones born with the aid of forceps, vacuum extractors or surgery – things that can cause even more problems for infants. These instrumental and surgical births also cause injury, scarring and adhesions in mothers’ bodies. This leads to more space and mobility restrictions causing difficulties for future babies who try to get into good positions for birth.

The Baby Who Descends Too Soon
I know that there is an equally serious problem of the baby who descends into the mother’s pelvis too soon. When I realized this, it was a big eye-opener for me. I now believe that babies shouldn’t descend deeply into the mom’s pelvis until just before or during labor. The idea of it being normal for a baby to “engage” weeks before birth really doesn’t make sense. Babies who reside deep in the mother’s pelvis for weeks can’t move freely enough to get out. If they could move they would. Movement on many planes including in and out of the pelvis is the norm.

Think about it. We say it is normal for a first baby to engage weeks before birth and simply stay there. Do we say that about the next baby? Nope. That’s because it happens less often when a mom has already given birth. These second and subsequent babies may bob up and down until just prior to or during labor. This happens because those experienced moms often have better pelvic mobility, better mobility of the ligaments that support the uterus and better mobility of the uterus itself. The movements, growth and birth of previous babies have helped release some restrictions creating more mobile space for the next baby. Although, giving birth can also create new restrictions in a woman’s body.

Some babies are forced deeply into the mother’s pelvis early in their development because the mother has restricted movement in her abdominal organs – maybe since she herself was developing in-utero. The baby has insufficient space to grow above, descends down into mom’s pelvis and stays there. Some experts believe that this too-early descent contributes to premature birth due to excessive prolonged pressure from the baby’s head applied to the mother’s cervix.

The Baby Who Develops a Wry Neck (Torticollis)
Early-descending babies are more likely to be born with torticollis. Torticollis is sometimes a nerve injury, but usually a condition where the length and strength of the neck muscles are asymmetrical. These babies have been jammed into positions where their heads are laterally flexed and/or rotated. They couldn’t move their heads normally as they developed.

In-utero conditions that contribute to torticollis include being one of a pair of twins, short umbilical cord, low amniotic fluid, restrictions in mom’s abdominal organs, uterine restrictions, uterine scarring or anomalies, and restrictions in the ligaments that support the uterus.

Babies who have torticollis can be very uncomfortable in their bodies. They are more likely to be the babies who favor one breast. It may actually be painful for them to turn their heads both ways – even a little.

These babies need bodywork, positional intervention and exercise to mobilize and strengthen their necks. Waiting until they are sitting or standing is too late. Once babies can sit and stand their bodies will do whatever it takes to keep their eyes level with the horizon. If they can’t manage this with their heads and necks the accommodation will happen lower down in the spine – a recipe for pain and loss of function over a lifetime.

The Baby Who Develops a Flat Spot (Plagiocephaly)
I see lots of babies with flat spots on their heads in my practice. Some of them come diagnosed, some not. It is common for me to meet a baby who has plagiocephaly after the parents notice the baby developing a parallelogram-shaped head (viewed from above). They want to know if I can fix the baby’s face. First we need to “un-fix” the baby’s neck.

Here’s what happens: Baby Sally gets born with torticollis and nobody notices that she only likes to turn her head one way or maybe her parents don’t recognize it as a problem. Sally’s parents dutifully put her to sleep face up (Back to Sleep). She spends lots of time in a car seat, bouncy seat and a baby swing (firm surfaces). Soon a flat spot develops on one side of the back of the Sally’s head. Without intervention the flat spot gets bigger and flatter. Eventually gravity will start to collapse and flatten the opposite side on the her face. This is the cause of the parallelogram.

What Can We Do?
There is a lot that CST/VM practitioners can do to help babies resolve the things that happen to them during their gestations and births. The gentle hands-on treatments can release the contracted, shortened parts of their necks that lead to misshapen heads and developmental interruptions. We can help babies restore structural balance and optimal functioning in their bodies.

However, we really should be preventively treating the mothers – before the second stage of labor – ideally, before and throughout pregnancy if needed. Manual therapies can relieve restrictions in mothers’ bodies so the babies will have flexible, symmetrical space in which to develop. The babies will more easily drop into the mother’s pelvises at the ideal time and be in the best position for timely, efficient labors and gentle births.

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