Cranio Sacral for babies

maart 18, 2016
Artikel door Carol Gray, Cranio Sacraal Therapeut en vroedvrouw, zij geeft trainingen in de VS en conferenties over CS voor zwangeren, pasbevallen moeders en baby’s

Craniosacral therapy (CST) has evolved as a specialized branch of osteopathy. Osteopathy, developed in the US by Andrew Taylor Still, is a form of drug-free, non-invasive manual medicine that focuses on total body health including the body’s structural, organ, ner- vous, circulatory and lymphatic systems. At first, osteopaths were not especially concerned with structures in the crani- um because they were taught that cranial bones fuse at some point in our lives and that our heads don’t have moveable joints (like coconuts).
Early cranial osteopaths like William Garner Sutherland, DO, and Charlotte Weaver, DO, disagreed with the head- as-coconut model and began to develop assessment and treatment techniques that focus on what we now call the craniosacral system—the membranes, fluid and bones that surround, nourish, protect and sup- port the brain and spinal cord. They no- ticed that not only are cranial bones slightly moveable, but they also have a palpable movement or rhythm of their own. We now call this the craniosacral rhythm or cranial rhythmic impulse.

In addition to other assessment and treatment techniques available from the roots of osteopathy, craniosacral therapists use the craniosacral rhythm as an assess- ment tool and treatment opportunity.

CST is a gentle, noninvasive type of bodywork. This gentle touch is one of the things that sets CST apart from all other forms of manual therapy.

How Did I Get Started?
From a medical standpoint, most of them were normal, but they needed help. They just weren’t functioning optimally. They had trouble with feeding. They weren’t com- fortable in their bodies. They cried a lot. Some had experienced instrumental births (forceps or vacuum extractor assisted). Some were surgically born. My instincts told me something was wrong with these babies. The babies themselves drove me to find a way to help.

After months of searching for a teacher, I began studying craniosacral therapy. I knew this is what I needed to learn to help the babies. My training was great, but un- fortunately, it did not prepare me to work with infants (or their mothers). What my CST teachers taught about pregnancy, the birth process and babies was sometimes inaccurate, often fear-based, always taught from the medical model and rarely taught from direct experience.

In my second CST workshop, I got to watch a baby treatment demonstration and listen to a 30-minute lecture about clinical considerations (pediatric conditions that might respond to CST treatment). Then I was on my own. The good news is I had lots of opportunities to treat babies. The word spread in my community about the benefits of CST, and my bodywork practice shifted to mostly infants. I continued studying and did my best to figure out how to merge what I was learning about adult CST with what I was teaching myself about embry- ology, gestation, the birth process, infant anatomy, breastfeeding, etc. Over time, I developed effective techniques and tools that got great results for newborns and older babies.

My birth doula practice morphed into a midwifery apprenticeship and I subse- quently spent 12 years practicing as a pri- mary homebirth midwife. This gave me additional opportunities to develop ways to integrate CST into prenatal care, the birthplace and postpartum care for both moms and babies.

also seeks structural homeostasis—coming back to wholeness in a sense. Newborns are closer to wholeness than any of the rest of us. This is one of the reasons why they are so easy to treat and our results can be so spectacular.
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All of our body parts should move independently of their neighbors. These body parts may be muscles, bones, organs, blood vessels, nerves (anything!) all the way down to the cellular (or sub-atomic particle) level. Sometimes parents ask me if they will undo the work by dressing or bathing their baby. It’s a reasonable ques- tion when you consider the gentleness of the work. I explain that I don’t put baby bodies into a particular alignment. My goal is to facilitate mobility so the babies can find their own alignment. Once the mobility is established, it takes something like trauma, infection or movement re- striction (swaddling or overuse of infant “furniture” like car seats or Bumbo seats) to inhibit it again. Normal daily activities won’t cause problems.
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I don’t heal babies. They heal them- selves. My midwifery experience compels me to carefully consider what exactly is needed in each situation. I always ask, “What would happen if I do less?” My goal is to offer the smallest intervention necessary to stimulate the body to find bal- ance. That is all it takes. The human drive for balance is so great that we really don’t need to do very much as long as we are listening to the body and providing what is really needed. Sometimes babies need a witness. Sometimes they need someone or something to organize themselves around or push against. I trust babies to show me what they need. CST could be called the homeopathy of bodywork.

I once attended a birth with an experienced mother. She was in the tub as her baby’s head emerged. The baby’s shoulders, however, got stuck. The mom had great maneuverability. She instinctively did some lunges and with her own hands freed her baby’s shoulders. The baby emerged not breathing and had the characteristic purple face of a shoulder dystocia baby.

I have been practicing infant craniosa-cral therapy for over 20 of my 25 years as a bodyworker. In the early days, I called myself “a massage therapist who also goes
to births.” The term doula had not yet been coined to describe the modern labor sup-
port profession. One day, I was at a gathering of birth professionals—mostly home-
birth midwives. I overheard a conversation between two midwives. One asked the
other, “Do you do cranial adjustments on all the babies in your practice?” Her answer  was yes. I was too shy to ask what that was, but I knew that I wanted to learn how to do it.
At the births I attended, some of the babies looked as if they needed help.

What Do I Really Do?
The following took place over less than a minute: We did all the usual things like drying, stimulating and talking to the baby. For my partner to hand me the bag and mask, I monitored the baby’s heart rate and held her head with my other hand. I noticed that her occiput was jammed into her sphenoid. As I gently freed it, she began to breathe. Immediately prior, her heart rate had slowed to the point of secondary apnea. Babies aren’t supposed to come back from that without positive pressure ventilation. Why did a cranial base release work? I speculate that this baby had some compression in the jugular foramina leading to vagus nerve compres- sion interfering with respiration. Freeing this area allowed her to begin breathing on her own.

Structure and function are interrelated. Imagine that a newborn cannot easily turn his head to his left. This may go unnoticed by parents who only see that he can’t nurse well at the mother’s right breast. The reason he can’t nurse well on the mother’s right breast is because he can’t comfortably turn in that direction. His tendency is to turn the other way. The mother may think there is something wrong with her right breast or the milk that comes out of it. In this case, the struc- ture of the baby’s body has a direct effect on his functioning at the breast. Over time if the baby cannot transfer milk ef- fectively at that breast, the milk supply, of course, will be affected.

This story isn’t about a newborn, but it’s a compelling example of the source of pain or loss of function not being obvious. I went to the home of a 2-year-old whose parents had requested a treatment because she had persistent fluid buildup in her left middle ear. They were on the brink of get- ting surgically-implanted tubes because the child was losing her language due to hearing loss. I had attended her birth as a doula. I’d been in touch with the family. I knew she hadn’t experienced problems like this before. Ordinarily, with these symptoms I find a restriction of mobil- ity around the eustachian tube that I can assess and treat by manipulating the tem- poral bone, but not in this case. When I began to assess the child, I found lots of tension and restricted movement around her left shoulder extending up into her throat. I asked the mom what had hap- pened to her. Mom said, “Didn’t I tell you? She was playing with her brother and fell out of the top bunk and broke her collar bone a while back.” If I had used some protocol or recipe-driven ap- proach, I would have missed the source of this problem. After one treatment, her ear cleared and her hearing was restored.

Feeding Issues
Newborns with breastfeeding problems are number one on the list of who I see in my practice. It is far more common than babies presenting with digestion, sleep, teething, colic, excessive crying and other important issues. Moms expect breastfeeding to work. If breastfeeding isn’t working, moms are likely to seek help from lactation consultants. When standard lactation tools don’t fully solve problems, babies are increasingly referred for CST.
Feeding difficulties are symptoms of incompetent babies. Feeding ability is one of the most important indicators of whether a baby is really ready to succeed in the world and whether he/she is neuro- logically intact. Even if the moms give up on breastfeeding, the underlying problems will persist. Breastfeeding is a baby-driven system. It’s very rare for the mom to have a breast issue, such as insufficient glan- dular tissue, that causes a breastfeeding difficulty. Difficulties at the breast are the first signs that a baby is compromised in some way. Babies will develop compensa- tions, but without getting at the underly- ing cause, things may not change enough to salvage the breastfeeding relationship.

Some babies with feeding issues have tongue/lip ties also known as tethered oral tissue (TOT). During embryologic development, some oral tissues such as the tongue, the mandible and the floor of the mouth are all one structure. At some point, these structures are supposed to differentiate and separate. When that doesn’t happen normally, the babies can benefit from frenotomies (scissoring or lasering the redundant tissue) to release the tongue from the floor of the mouth or the lip from the alveolar ridge. The pro- cedure frees these structures for normal range of motion. Some of the babies who have these procedures also have restricted tongue mobility due to cranial nerve dys- function or restrictions originating else- where in the body that extend into the floor of the mouth. Their issues will not fully resolve with a procedure alone. They also need manual therapy. CST is by far the most recommended type of manual therapy for these babies.

Most of North America is struggling to learn that tongue tie (ankyloglossia) or TOT is not a fad diagnosis, but an actu- al problem that has a detrimental effect on breastfeeding. Portland, where I live, has swung the other way. I am now see- ing babies long post-revision who never got the desired result because what they actually had was cranial nerve dysfunc- tion and/or tissue restrictions originating from elsewhere in their bodies. The moth- ers may have stopped seeing a lactation consultant and they may have given up on breastfeeding. Now other problems such as sensory issues are emerging for the baby. Those of us who practice infant CST are the ones who see these tongue tie revision non-success stories. In fact we are seeing proportionately fewer ba- bies whose breastfeeding instantly and dramatically improves post-revision and more of the babies whose breastfeeding doesn’t change or only improves a little post-revision.

I am seeing an increase in babies who have a combination of TOT and other is- sues treatable with CST. I typically see those babies post procedure. The frenot- omy providers in Portland are routinely sending them. Those babies do well with a procedure, good lactation support and CST.

We don’t have any research to show which kind of after care is best for ba- bies post frenotomy. This gives me a great opportunity to advance my own ideas alongside the rest. One of the goals of the common after-care instructions is to do stretching/sweeping of the wound area to prevent the ends of the diamond-shaped wound from healing back together. The thing that is most interesting to me is to learn what parents are doing. I see babies who mostly come from two frenotomy providers. The doctors give nearly iden- tical after-care instructions. What the parents are actually doing is all over the map. I know. I ask the parents to show and describe for me what they do or don’t do. Some parents avoid doing the care because it hurts the baby. Some babies end up with new oral restrictions at the procedure site weeks later. I suspect that the overly vigorous after-care “exercises/ stretches” may be stimulating inflamma- tion and result in adhesions later. I favor a slow, gentle approach—a CST-like touch. If the object of the after care is to keep the ends of the wound apart, it shouldn’t matter if it is done slowly and gently. In fact, it should help.

Weird Head Shapes and Twisted Babies
I see lots of babies with flat spots on their heads in my practice. The most common variety is the broad flat spot on the back of the head called brachycephaly. It is an artifact of the “Back to Sleep” program and time spent in car seats, baby seats and swings that have a flat, firm surface. My mantra is: Back to sleep, tummy for play, car seats only for car rides and in arms or soft carriers the rest of the time. Of course, this doesn’t mesh well with what most Americans actually do with their babies, especially the car seat part. I have been treating infants since just before the Back to Sleep program was launched. I have seen alarming changes in babies over the years. Supine sleeping causes develop mental delays. The (controversial in my world) Back to Sleep program has argued baby will have a hard birth with a probably saved the lives of babies, although, longed, non-progressing labor likely re-we don’t really know how many and we aren’t sure why.

The second most common kind of flat head shape is positional plagiocephaly, a flat spot on one side of the back of the baby’s head. Usually, this is caused by the things listed above with the addition of torticollis. Torticollis used to be called wry neck syndrome.
Torticollis is not a birth injury. It is a persistent problem that takes days, weeks or months to develop in utero. Think club foot of the whole body that looks like a neck problem. The neck moves more eas- ily than the trunk of the body. Therefore, it looks like it is the problem. Actually, in almost all cases, the torque or twist comes from the pelvis or somewhere in the baby’s trunk.

The actual in utero conditions that contribute to this include being one of a pair of twins, a short umbilical cord, low amniotic fluid, restrictions in mom’s
sulting in an instrumental or surgical birth. The birth itself, however, is not the cause of the problems that persist after the birth.

My abdominal organs, restrictions, scarring or anomalies in mom’s uterus, restric- tions in the ligaments that support mom’s uterus and a sedentary maternal lifestyle The actual list is longer, and sometimes it just happens.

There is a lot that CST practitioners can do to treat torticollis. I give parents information about how to alter their care- giving and play activities so babies can develop balanced length and strength in their bodies and enhance the effects of the bodywork.

Birth Trauma
So-called “bad births” or birth trauma are not ordinarily the cause of the prob- lems we see. Static, twisted inter-uterine lie causes most of the persistent problems we see. Restriction of movement in utero often causes “bad” births. An example of this is the baby who drops days, weeks or months before the onset of labor into an asynclitic presentation and then gets stuck. The mother may proclaim, “My baby has dropped!” This, however, is not cause for rejoicing. If the baby can’t move in and out of the pelvis, the real proclamation should be, “My baby is stuck!” Babies rarely get stuck in ideal positions for healthy growth and trouble-free birth. 

Over the years I have seen a sharp increase in asynclitic and other less than ideal positions for gestation and birth. As a CST practitioner, I have worked hard to develop bodywork techniques that mo- bilize structures in maternal bodies so their babies have optimal space to grow, develop and assume ideal positions for birth. Prevention is best, but the easiest and most effective correction is done very soon after birth.

CST Should Be in Every Midwife and Lactation Consultant’s Tool Bag
CST is easy to learn and treating babies is easy to do. It’s simple to incorporate CST evaluations and treatments into newborn exams and lactation visits. It makes sense to add these services to the visits midwives and lactation consultants are already offer- ing. The newborn period is the best time in life to receive CST care. The things we see in newborns are simple to treat. Left untreated, they can adversely affect babies throughout a lifetime.

Carol Gray practices and teaches infant and maternal CST in Portland, Oregon. She is a retired homebirth midwife. Carol is passionate about using her CST skills to gently make space in maternal bodies so babies can assume ideal positions for gestation and birth. She is currently developing specialized prenatal yoga classes to support and enhance the maternal bodywork techniques she practices and teaches.