What Happens During An Assisted Birth and How Can a Paediatric Osteopath Help?
The second stage of labour is when you actually deliver or birth your baby. Your body and your baby’s body need to work together complete this amazing process. Second stage labour can slow down or stop for any number of reasons: if you are stressed (for example, by pain, fear, or are having difficulty following someone else’s orders to push), or if your baby is stuck.
If the delivery is taking too long, obstetricians will usually recommend intervening to minimise the risk to you and your baby. They will usually recommend an assisted birth, using ventouse or forceps to help deliver your baby.
Babies cranial bones move during delivery – moulding
During birth, your baby’s cranial bones move and overlap to allow their head to fit through the birth canal (the medical term for this is ‘moulding’). Within the first few days after birth these bones will shift back into their final position and your baby’s head will resume its expected shape (ie not so cone-shaped).
The choice to use instruments indicates that your baby’s head is stuck and therefore has reached the limits of normal moulding. The extra pressure applied by both ventouse and forceps therefore have the potential to add additional ‘unphysiological’ forces, causing strain to babies’ cranial bones and ligaments.
This strain often resolves by itself (babies are made of very healthy stuff!) but the placement of the forceps or ventouse pressure required to deliver your baby may also determine the impact of assisted delivery.
What is a ventouse and how is it used?
In ventouse delivery, a cup is carefully attached to the top of your baby’s head over one cranial bones with a very light vacuum pressure which allows the obstetrician or midwife to gently turn and pull your baby as your contractions push from the other end. This process may leave a fluid filled bump or bruise on your baby’s head which disappears over a few days. The process is often quick and effective and leaves no bruising.
The strength of your contractions, how tucked in your baby’s chin or rotated their head is (to align with the widest part of the birth canal), determines the amount of pulling or turning required by the midwife/obstetrician.
What are forceps and how are they used?
With forceps, more traction (pulling) and rotation of the baby’s head is possible as they can be applied to the widest (and most robust) part of your baby’s head. Ideally forceps are used with precision, but in reality a tremendous pulling force may be required which is not natural to the primal birth process (which is essentially a pushing force). The amount of pressure is dependent on the degree of urgency and the distance the baby still has to travel down the birth canal.
Babies usually recover from all types of birth quickly
Newborns are usually relieved and soothed by lots of skin to skin contact, soothing and feeding over the weeks immediately following birth. Nevertheless, some babies still appear uncomfortable despite gaining weight and getting plenty of cuddles and sleep.
Paediatric, cranial or baby osteopaths are often able to detect some degree of strain and sometimes facial or head shape asymmetry due to the traction and/or rotation forces applied by these instruments.
Can you see the strains?
The strains are rarely visible, but can manifest themselves in problems latching, difficulty settling when not in mum’s arms, or constant/unexplained crying. There may also be puffiness or weepiness of one eye more than the other.
One visible strain but injury sometimes caused by forceps application is temporary facial nerve damage, due to pressure on the nerve. The facial nerve controls the muscles of facial expression and when affected creates asymmetry of expression (when crying), the baby’s inability to correctly close their eyelid and trouble suckling due to the baby’s inability to seal their lips around the nipple.
Is it stressful for the baby?
Aside from physical ailments it is important to remember the reason for an assisted birth is usually due to a complication, and is often associated with stress to the mother and/or baby. Successful breastfeeding, nurturing and skin to skin contact often washes away the stress of delivery.
However, some babies delivered with instruments appear to hold tension in their ribcage and diaphragm area, possibly as a reaction to the strong pull or stressful circumstances of the delivery.
Babies may also seem colicky simply due to muscular strain or tension causing altered feeding mechanics and difficulty with digestion.
Paediatric osteopaths are trained to take a thorough birth, feeding and growth history and perform a comprehensive musculoskeletal examination. This helps them determine whether your baby’s feeding / digestive issues are likely to have been contributed to by stresses during their birth processes and whether they are able to use osteopathic techniques to help resolve the strains or make recommendations to other healthcare practitioners where appropriate.
Written by Melissa Andrew