Positive Health Online

There are nearly 100 trillion cells in the adult body. In each cell there are many thousands of metabolic processes occurring at any one time. It is astonishing how the organism manages to maintain its coherence in these circumstances and even more astonishing how little ill-health is experienced by most of us most of the time.

As adults we are not aware of the processes that allow us to remain healthy and functioning. There some obvious variations in our states, which occur on a regular basis such as sleep, hunger with the need to eat and times when we need to void wastes.

Checking the Motion of the Ilium

Within these rhythmical changes we maintain a generally steady state as adults, overlaid with a gradual adaptive and ageing process. This is maintained despite the organism having to constantly adapt to changes within the internal and external environment, which are occurring all the time. The immune system is on a constant state of alert as we come into contact with organisms and toxins that threaten this equanimity. Our level of alertness is constantly varying due to changing circumstances.

Within certain parameters our bodies are thus very plastic and adaptable, and with time and changes of circumstances it allows us  to adapt to the uncertainties of the future.

Women are slightly different during their reproductive years when their bodies are in a state of preparation for pregnancy or pregnant or nursing. The cyclical changes as described are often modified by medication and behaviour in the modern world which suppress these cycles. However, pregnancy and birth, other than in acute illness, are times when we experience this adaptability and plasticity the most.

As an individual developing in the womb from one cell to a complete but immature organism, changes take place rapidly, similarly for the mother whose mature physiology has to change and adapt to accommodate the developing embryo and foetus, the unfolding process seems miraculous.

From an osteopathic point of view it is an ideal scenario when an existing patient becomes pregnant and one has the opportunity to take her through the pregnancy and to check both mother and baby after birth. In this situation it is possible to prevent problems from occurring by pre-empting them.

By knowing the history of the patient and having treated structural problems that give rise to dysfunctions, one can predict the effect of the changes in weight bearing, centre of gravity and shape of the spinal curves, as well as the growth of the uterus and the subsequent accommodation by the internal organs.

Back pain, neck pain, headaches, reflux, constipation and varicosities are among the more common symptoms experience by the mother during this process. While some of the predisposing factors in the development of these symptoms are uncontrollable such as age, weight at time of pregnancy, history of injury, surgery etc., they may be eased by carefully directed treatment.

So what are these changes and how may they be managed?

• Hormonal changes allow loosening of the ligaments to accommodate the increase in spinal curves;
• Breast development adds load to the thoracic spine in particular;
• Transition points in the spine come under strain;
• Uterus increases in size exaggerating any imbalances in uterine ligament tensions;
• Abdominal organs become displaced and in the latter stages can become under pressure;
• The respiratory diaphragm comes under tension in the later stages;
• Blood flow return may become impeded with resulting varicosities in veins of the legs and or abdomen as well as haemorrhoids;
• The abdominal wall becomes stretched.

The osteopath can help to mitigate the development of any of the above by identifying and where possible treating the predisposing factors. Some predisposing factors include:

• Age of mother at conception. In modern times many women are choosing to have their first children at a later age. This may be due to social and economic factors as they wish to establish a career, or to be financially secure before they start. From a purely physical point of view, early 20s is probably the optimum age when the body is full developed but young enough for accommodating the physical demands of the pregnancy easily;
• Physical condition of mother; This includes physical fitness, state of health, both physical and emotional, the shape of the body in particular the pelvis where the shape and size contribute to success in parturition, history of illnesses and accidents and personal circumstances including social factors and nutritional status;

It seems obvious that if the mother-to-be is unfit then she lessens her chance of a trouble-free labour and birth. Less obvious is if she is an accomplished athlete; this may similarly impede the success of the process. In the case of the unfit the poor tone of the body tissues is the problem. In the case of the athlete too much tone may an issue. I have come across women Pilates instructors and female jockeys who have had problems for this reason. Exercise can help to manage these factors. Yoga, swimming and walking are all excellent for the unfit and for those with hypertonic soft tissues, specific stretches will be helpful.

• Toxic load. Modern life predisposes us all to carry more toxins in our tissues than hitherto. These can arise from medications, antibiotics, pollution, cosmetics, fire retardants and so on. Many of these substances are endocrine disruptors and oestrogen mimickers. Many women of reproductive age used chemical contraception. All of these factors together influence the development of dysfunctions of the reproductive system including dysmenorrhoea, polycystic ovaries and pathologies such as pelvic inflammatory disease (PID). The success of the pregnancy can be adversely influenced in this way. Naturopathy and homotoxicology can contribute to a lessening of the toxic load and a contribution to a successful outcome.

The ability of the osteopath to assess structural imbalances in the absence of symptoms is also very successful in pre-empting the development of negative outcomes.

Perhaps the structure to check first is the pelvis, which is the foundation for the mechanics of the whole body, as it has to distribute load from above as well as protect and nurture the pregnancy. A common finding and often asymptomatic is an anteriorization of the sacro-iliac joint. This may result from habitual factors such as repeatedly crossing the legs or minor trauma resulting from the leverage occurring when bending twisting and lifting. This is easily corrected. The other joints of the pelvis; the lumbo-sacral, the pubic and the sacro-coccyx need checking and correcting too.

Mechanical pelvic dysfunction can also lead to disturbance of function of the parasympathetic autonomic outflow from the sacrum and thus the functioning of the pelvic organs. The other area crucial to the parasympathetics is the upper cervical spine.

Similarly the lumbar and thoracic spine can affect the sympathetic autonomic nerves to the organs.

The cervical spine is a structure that is subject to trauma such as whiplash where the normal lordotic curve can be reduced influencing the rest of the spine and reducing the mechanical efficiency of the whole unit.

The fascia, in particular the structures associated with the ‘diaphragms’ such as the sub-occiput, the thoracic outlet, the respiratory diaphragm and especially the pelvic floor need to be correctly tensioned often-using gentle functional techniques. Balancing the fascia and ligament tensions of the uterus during this time will also optimise the factors influencing a successful labour.

The craniosacral system needs to be in balance too. This can be disturbed from the beginning of the mother-to-be’s life form mechanical factors in her mother’s womb and abdomen to the birth, followed by trauma, dental work and infections such as otitis media.

Craniosacral disturbance of the structures of the cranial base may be theoretically associated with dysfunction of the pituitary gland and thus hormonal disturbance.

In the ideal situation, having dealt with these predisposing factors the therapist will then manage the mother during the pregnancy dealing with mechanical changes as they occur.

Psycho-emotional factors are also extremely important. Some of these factors are best dealt with before or during the pregnancy, especially dealing with negative emotions and expectations and fear. More specialist help may be required in certain circumstances. In the labour it is understood that a relaxing and empowering environment is an important factor in the obtaining the best outcome.

Checking Cranium of the Newborn

The presence of an osteopath at the birth can be very helpful in modulating the changes that occur during the process. Unfortunately due to medico-legal issues this is not often possible. However I was privileged recently to be present at the birth of my daughter’s first baby and was able to free the mother’s sacrum, which was catching at the left sacro-iliac joint before she went into the birthing pool and just as the pelvis was opening out to allow the passage of the baby. This kind of intervention helps to facilitate the descent of the baby through the pelvis.

During the weeks after the birth any imbalances in the mother’s structure can be resolved.

Treatment during pregnancy and in the aftermath is helped by the plasticity and adaptability of the system and as well as helping the process occur it is also an opportunity to resolve some of the older structural issues in the mother’s body.

In nine months the one cell of the fertilized egg expands into a being of about 5 trillion cells all working together in harmony. This oft repeated miracle occurs despite the challenges outlined above. The skill of the supporting cast be they family, friends, doctors, nurses or complementary therapists can help achieve the most favourable outcome. In truth the star of the show is the mother who has to bear the most difficult and painful challenge and deserves the greatest reward of all.

Further Reading

Gordon, Y  Birth and Beyond, London: Random House.

Stone CA. Visceral and Obstetric Osteopathy, Edinburgh, Churchill Livingstone. 2007.

Upledger J, Vredevoogd J. Craniosacral Therapy, Seattle, Eastland Press. 1983.