by Michael Kern
A baby’s skull
Moving through the birth canal on a journey into the world is our first experience of meeting any strong physical resistance. In order to be born, a baby has to be literally squeezed through the narrow tunnel of its mother’s pelvis. At this stage, an infant’s skull is only partly formed and provides a superb balance of protection and pliability. This pliability is necessary to enable passage through the birth canal and to accommodate for any strong forces that may be encountered.
At birth, the vault bones at the top of a baby’s head largely consist of unfused membrane, which allows for enormous changes of shape. The places between the bones where this membrane remains soft are called the fontanelles (see Figure 10.1). There are large fontanelles at the front (anterior fontanelle), at the back (posterior fontanelle) and at the sides (sphenoidal and mastoid fontanelles) of the skull. The bones at the floor of the skull, the cranial base, consist largely of unfused cartilage. This cartilage also allows for a reasonable degree of flexibility, and at the same time offers protection to the delicate organs at the base of the brain.30
Many of the unfused bones of a baby’s skull consist of separate parts. The fusion of these bones is a process that often doesn’t complete until about seven years of age. Until the time that fusion occurs, Dr. Viola Frymann notes that, “Each portion of these bones may be regarded functionally as a separate bone, capable of moving in relation to its neighbor.”31
Figure 10.1: A baby’s skull (illustration credit 10.1)
At birth, the frontal bone is in two parts, the temporal bones in three parts, the sphenoid bone in three parts, and the occiput in four parts (see Figure 10.2). The pelvis is also in three parts. As these bones meet with resistance during the birth process, they become liable to distortion. This often leads to patterns of compression that affect not only the bones themselves but also the underlying tissues. For example, if the different parts of the occiput become compressed, the diameter of the foramen magnum may be reduced (see Figure 10.2). This can put pressure on the brainstem and the upper part of the spinal cord, both of which pass through this opening. Distortions can also cause irritation of the cranial nerves that emerge from smaller openings in or between the bones of the skull (see “Effects on the nervous system”).
Figure 10.2: i) The four parts of the occiput at birth; ii) Distortion of the occiput (illustration credit 10.2)
Cranial molding
As a baby’s head passes through the birth canal, it is squeezed into shapes that are determined by the contours of its mother’s pelvis. These strong forces of compression often last for several hours. The bones of its skull bend and overlap as they are squeezed together, in a process called cranial molding. Furthermore, its body has to twist around, making a ninety-degree rotation in order to gain exit. While this process is potentially traumatizing, it is also highly stimulating. These forces are very important in awakening the baby in preparation for its entry into the world and initiating the process of secondary ignition.32
It seems that the manner of our birth is one of the most significant experiences, as well as one of the greatest challenges we face. Most, but certainly not all, babies feel to some degree traumatized during this time. Nevertheless, many of these stresses are naturally rectified within the first ten days, as the baby’s self-healing forces come into play. The underlying influence of primary respiration, aided by the actions of suckling and crying, can sort out many of the less serious results of compression, allowing the baby’s head to re-expand and rebalance.
Unresolved inertia
However, stresses from birth commonly create inertial patterning that is at the root of many psychological and physiological issues affecting the health of babies, children and adults. Difficulties can range from the more severe type such as brain damage, epilepsy or autism, to less severe problems that are often considered normal. Common symptoms include feeding difficulties, colic, excessive crying, irritability, poor sleep, developmental problems, emotional distress, or ear or sinus problems.
Birth trauma also influences early patterns of movement that can become permanently adopted. This can first be seen as asymmetries of motion or a strong preference in position. For example, if the baby only likes to feed on one side, it may suggest some neck strain. Or, parents may notice that their baby is uncomfortable when lying on one side. In many instances, these preferences are sufficient to cause an alteration in its pattern of growth.33 All of these may be palpated as inertia and distortions in the rhythms of primary respiration. According to Dr. Ray Castellino, the patterns of motion adopted by a baby mirror the events that occurred during its birth. The pattern of birth also directs the sequence of a baby’s movements and ways that it holds itself.34
Emma’s story
Emma was three years old when I first saw her. She suffered from repeated ear infections, “glue ear” and partial deafness. Her sleep pattern was also very erratic, and she would often wake suddenly, as if in a panic. Emma had been born after a long and difficult labor. She was stuck in the birth canal and in distress when the umbilical cord became caught around her neck. Eventually forceps were applied to the sides of her head to pull her out. Her mother had also been given an epidural injection to ease the pain.
Emma’s head felt very hard, and her subtle rhythmic motion had a jerky quality, indicative of shock still held in her tissues. There was a lot of tightness and sensitivity in her cranial membranes and a compression of her left temporal bone. (The organs of hearing are contained within the temporal bones.) On the basis of these findings, I started treatment. Emma seemed to like the gentleness of craniosacral contact and even took my hands and placed them at the sides of her head, as if to say “This is where I need them!”
After the first two sessions, during which I worked with her cranial membranes and temporal bone, Emma’s sleeping pattern showed some slight signs of improvement. Her mother also reported that Emma seemed less bothered by the discomfort in her ear. However, she then got another ear infection, and so I advised her mother to reduce dairy products in Emma’s diet to help prevent excessive build-up of catarrh.
During the third treatment, Emma started to push her head against my hands, as if trying to resolve some of the tension in her skull. My hands provided her with some resistance to push against, and to Emma’s great delight, she pushed right through and ended up in my arms. It seemed that she was reproducing the same movements that occurred during her birth. Emma slept for hours afterwards. When I saw her at the next visit, she looked brighter and more alert. Tests a couple of weeks later showed an eighty percent improvement in her hearing. We followed up with another three treatments which helped to further restore the expression of primary respiration through her head. By the end of this course of treatment, Emma had made a complete recovery in all of her symptoms.
Getting stuck
If a baby gets stuck in the birth canal and the compression it experiences is unresolved, the sensation of feeling stuck can repeat itself in later life. This commonly happens when they find themselves under stress or in an enclosed space. These situations can restimulate the memory (usually subconscious) of their birth process. Life statements such as “There’s no way out!” or “I can’t get anywhere!” may consequently develop. Generally speaking, the earlier these inertial patterns can be addressed, the easier they are to treat.
Brenda’s story
Brenda, a successful businesswoman in her early thirties, suffered from claustrophobia. She had a great fear of flying, made all the worse by the fact that her work sometimes demanded that she travel. She would go into a panic, shaking uncontrollably, sweating profusely, heartbeat pounding, with rapid breathing and tight neck muscles. Sometimes she would even vomit. She reported her birth was long and difficult and that she had become stuck in the birth canal and nearly died.
Was her difficult birth the source of her distress? Perhaps this trauma was getting recapitulated whenever she felt trapped. On palpation, I found that there was a twist t
hrough the floor of her cranium and a compression pattern between her occiput and top vertebra of her neck. This may have been creating some irritation of her nervous system, perhaps including the vagus nerves (hence the rapid breathing and vomiting). We worked with these patterns with regular craniosacral therapy treatments over a period of about a year. Some sessions were very calm and soothing, while others involved strong involuntary movements of her body as the layers of shock held in her system were processed. Little by little, a re-organization of the tissues of her skull took place and gradually Brenda no longer suffered from the same fearful reactions to enclosed spaces.
Asymmetries
The influence of birth patterning can often be seen as asymmetries of the head and face. In fact, there are not many people who do not have some marked differences between their right and left sides due to their birth. Any anomalies in your own skull can be seen by duplicating a photograph of your portrait onto two clear sheets of acetate, and then cutting each picture down the middle. This will give you two pictures of your left side and two pictures of your right side. If you then reverse one of the pictures of your left side and join it together in the middle with the other picture of your left side, you will have created a photograph of yourself comprised of two left sides. Also join together the two pictures of your right side, so that you have a composite picture made up of just the right sides of your head. You can then clearly see how different your face would look if made up of either two left or two right sides.
Life and death patterns
Illustrating the dramatic influence that the nature of our birth can have on our lives, studies in Sweden have shown a strong correlation between suicide and birth trauma. When conducting research in six Stockholm hospitals with patients who died from drug abuse, alcoholism or suicide, it was found that, more than any other risk factor, birth trauma was the greatest.35 Furthermore, studies with adolescent suicide victims at the Karolensha Institute in Sweden showed that the type of trauma suffered at birth closely correlated with the method of suicide. For example, 2,900 cases in the survey who had died of asphyxiation had also suffered some kind of asphyxiation at birth. Many of those who had experienced a mechanical trauma at birth such as being injured by forceps had killed themselves by a mechanical procedure. The suicide victims who died from drug addiction had a strong correspondence with the administration of opiates and barbiturates at their birth.36 If these correlations were more widely known, I wonder whether so many doctors and parents would so readily elect for interventions?
Good enough
Because of the complexity and variety of difficulties that can arise during pregnancy, birth and early childhood, it is unlikely that any parent will ever “get it all right.” If they experience a difficult birth, particularly one with many medical interventions, deeply loving and conscientious parents often feel a sense of disempowerment or failure. Furthermore, it can be quite a sobering revelation to discover just how conscious, responsive and sensitive a developing baby actually is. Nevertheless, being a good parent and providing children with a good start in life is not about being perfect or making no mistakes, but more about being good enough. For most parents, the time of pregnancy, birth and parenthood is an on-going learning curve!
Natural childbirth
Within the last twenty years, there has been a resurgence of interest in more natural approaches to childbirth. These approaches are intended to create an environment that makes things as comfortable and pleasant as possible for both mother and baby. Most importantly, a natural childbirth also encourages both to trust their natural instincts. This is in contrast to practices in many hospitals where mothers are routinely made to stay on their backs to give birth, drugs are administered and the baby is often pulled out under force. The newborn then enters the glare of lights and the noisy excitement of the delivery room—only for its umbilical cord to be immediately cut. It’s hardly surprising that a newborn may contract to defend against these insensitivities.37
A more caring approach to delivering babies has been pioneered by obstetricians Dr. Frederick Leboyer and Dr. Michel Odent. Instead of becoming patients who hand over all responsibility to the doctor, mothers are supported to take charge of the birthing process and to follow what they and their baby need. A mother is encouraged to choose her position, instead of taking it for granted that she has to lie on her back. In fact, it is usually much more difficult to give birth on one’s back or semi-seated, because the sacrum and pelvis are less mobile in these positions. This can make it more difficult for the baby to emerge. A squatting position is generally easier for giving birth, because the sacrum and pelvis are free to open and the force of gravity is usefully employed.
It has also been found that giving birth in water, initially pioneered in Russia, greatly helps to ease the pain of delivery and creates a smooth transition for the baby as it leaves the watery environment of the womb to enter the world.38 The support provided by water gives mothers far greater freedom to move around during labor, therefore making it easier to find the best positions that produce less pain. Furthermore, there is much anecdotal evidence to suggest that “water babies” are calmer, brighter and more alert. Birthing pools are now available in many hospitals or can be hired for a home birth.
Soft lighting, smooth and gentle sounds, warm air and sensitive handling provide a fitting welcome for the newborn, and help to create an atmosphere of support.39 The more that a mother is able to relax, the more likely it is that she will be able to stay in touch with her natural instincts and have an easier birth without the use of medical intervention. The role of the father or birthing partner is also of great importance to provide support and safekeeping. A partner’s presence and engagement with the birth can profoundly contribute to the sanctuary of the environment. When handled with sensitivity, an experience of excitement, joy and bliss can play as much a part in the process of childbirth as any of the challenges that mother and baby face.40
CAUSES OF COMPLICATIONS
Learn to respect this sacred moment of birth, as fragile, as fleeting, as elusive as dawn. The child is there, hesitant, tentative, unsure which way he’s about to go. He stands between two worlds.41
DR. FREDERICK LEBOYER
In order to explain some of the common issues that can be worked with in craniosacral practice, the discussions in this section include an outline of various things that can go wrong. However, this doesn’t mean that this is the way things need to be, or that deeply positive pregnancy and birth experiences do not often occur. After all, our bodies are designed for this purpose.
Whether or not a baby has a traumatic entry into the world and remains traumatized is determined by a number of factors; some of these may be under the control of parents and care-givers, and some are not. Normally, when talking about pregnancy and childbirth, any view or opinion tends to follow the point of view and experience of the parents or medical practitioners. It’s worth noting that this is not necessarily the same as the baby’s experience. In the summary that follows, many of the explanations will attempt to explain things more from the baby’s point of view in order to consider what they may experience as they enter the world.
Shape and size of the mother’s pelvis
Some pelvic shapes are much easier to be born through, while others provide more of a challenge. If the mother’s pelvis is very narrow or more triangular in shape, the baby may be unable to easily navigate a way through. The size of the pelvis is also of critical importance. With some pelvic types, a caesarean section is often carried out prior to the onset of labor to prevent complications (see this page).
Size of the baby
Babies vary greatly in size and, of course, the larger the baby the more difficulty it can have moving through the confines of the birth canal. Naturally, if the mother’s pelvis is also large, this is of less significance. The average baby weighs just over three kilograms (about seven pounds); any baby over four kilograms (about nine pounds) is generally considered large. A larg
e baby is more likely to get stuck and may also have difficulty getting its shoulders out once the head has been born.
Position of the baby
The position of the baby as it passes through the birth canal also determines the ease of delivery. Certain positions make for an easier exit, while others can create difficulties. The easiest position in which to be born is head first; this is the most common presentation. Less strain is also caused when the baby moves through the birth canal in what is called an anterior presentation. This is when the baby’s face moves down past the mother’s sacrum as it gains exit (see Figure 10.3). A posterior presentation is when the back of the baby’s head moves past the mother’s sacrum. It is more common for a baby to get stuck when in this position. The angle at which the baby’s head meets the pelvis at the onset of labor is also important. Its head is ideally tucked in against its chest, which creates the smallest possible diameter for it to pass into the birth canal. It also helps if the baby’s head is at a slight angle, rather than full-on, as it starts its descent.
Perhaps the most difficult way to be born is from a breech position, where the baby comes out bottom first. In this instance, forces of compression tend to enter the baby’s body from the bottom up, and its hips and pelvis often take the strain. Furthermore, the baby’s head doesn’t undergo the full benefits of proper molding. Other positions of birth, such as shoulder-first, are less common, but can also create patterns of strain or injury.